Mental health act ensures families no longer in dark
RUTH POLLARD
March 22, 2010
MATTHEW MURPHY'S mind snapped 11 months too early.
Had the 41-year-old been able to endure the crippling depression that enveloped him for a while longer, the state's new Mental Health Act would have required hospital staff to tell his family what was happening with his care. It may have saved his life.
But when he was taken by police to the Mater Hospital in Newcastle early on December 3, 2006, after telling his father he planned to shoot himself, his family were kept in the dark.
Less than two hours after he left the hospital - against medical advice and with doctors failing to pass on any information to his deeply worried parents and wife - he killed himself.
On Friday the deputy state coroner Paul MacMahon, handed down his findings into Mr Murphy's death.
He reiterated the need for communication - between police, doctors and family members - and noted the eternal struggle between protecting a patient's right to privacy and keeping them alive.
Police training should emphasise that family members can provide important background information and police handover forms should include family or carer contact details, the coroner recommended.
''The existence of a plan by Mr Murphy to kill himself was important for diagnostic purposes and that information was not provided to the hospital by police,'' he noted. He was critical of the police for dissuading Pat Murphy, Matthew Murphy's father, from going to the hospital, saying: ''Had he been there he would have been a source of information for the doctors and a support to [his son].''
Mr MacMahon also recommended the Mater Hospital amend its suicide policy to suggest that information can be obtained from family or carers without the consent of the patient if ''there is a risk to the patient''.
At a broader level, he said, doctors working in emergency departments must be made aware of the provisions of the NSW Mental Health Act, which gives them the power to contact family members without the consent of the patient.
It is a change that has been a long time coming, said the head of Lifeline, Dawn O'Neil.
''Family members have been saying for a very long time that when somebody has a mental illness their capacity to make decisions about their own care can be impaired, and the family members, in order to look after them, need information,'' Ms O'Neil said.
''When someone is at risk of suicide we have to take that very, very seriously - that person needs to be in intensive care … for some period of time.''
Pat Murphy campaigned tirelessly for an inquest into his son's death and is pleased with the coroner's recommendations, but has vowed to continue his campaign until the changes are adopted.
''There is no requirement on the local police and the area health service to enact these changes, but we have spent all this time and effort to try to get change - I will be following this all the way through,'' he told the Herald yesterday.
A spokeswoman said Hunter New England Health Service welcomed the coroner's findings and is giving the recommendations careful consideration.
Lifeline: 131114
Monday, March 22, 2010
NSW NURSES TO VOTE ON WAGES PROPOSAL
NSW nurses to vote on wages proposal
AAP
March 21, 2010, 3:21 pm
NSW nurses and midwives will start voting this week on a proposed wages and conditions claim, which includes a five per cent annual pay rise over four years.
The NSW Nurses Association (NSWNA) says nurses and midwives are also asking for mandated minimum nurse-to-patient ratios to be set to improve patient safety.
NSWNA general secretary Brett Holmes said a lot of work had been done over the last ten years rebuilding nursing as an attractive career option in financial terms and this was at risk of being lost.
"In the last couple of years nurses have again started to fall behind equivalent professions, such as the allied health professions, and if that continues we risk undoing what success we have had dealing with the nurse shortage," Mr Holmes said.
He said the majority of nurses and midwives were about $2500 per year or $50 per week behind physiotherapists.
"Our wage claim is, as well as properly rewarding the effort and dedication of nurses, aimed at keeping nursing and midwifery `up there' financially in terms of career options."
The NSWNA wants NSW Health to agree to a new four-year wages and conditions agreement, which includes a five per cent per year pay rise for all public hospital and community health nurses and midwives.
A five per cent pay rise on July 1, would provide the majority of clinical nurses and midwives with a pay rise of nearly $70 per week, Mr Holmes said.
AAP
March 21, 2010, 3:21 pm
NSW nurses and midwives will start voting this week on a proposed wages and conditions claim, which includes a five per cent annual pay rise over four years.
The NSW Nurses Association (NSWNA) says nurses and midwives are also asking for mandated minimum nurse-to-patient ratios to be set to improve patient safety.
NSWNA general secretary Brett Holmes said a lot of work had been done over the last ten years rebuilding nursing as an attractive career option in financial terms and this was at risk of being lost.
"In the last couple of years nurses have again started to fall behind equivalent professions, such as the allied health professions, and if that continues we risk undoing what success we have had dealing with the nurse shortage," Mr Holmes said.
He said the majority of nurses and midwives were about $2500 per year or $50 per week behind physiotherapists.
"Our wage claim is, as well as properly rewarding the effort and dedication of nurses, aimed at keeping nursing and midwifery `up there' financially in terms of career options."
The NSWNA wants NSW Health to agree to a new four-year wages and conditions agreement, which includes a five per cent per year pay rise for all public hospital and community health nurses and midwives.
A five per cent pay rise on July 1, would provide the majority of clinical nurses and midwives with a pay rise of nearly $70 per week, Mr Holmes said.
Sunday, March 21, 2010
PUTTING WEALTH INTO HEALTH IS WISEST
Putting wealth into health is wisest
By Paul Howes
From: The Sunday Telegraph March 21, 2010 12:02PM
ANY parent with young children can tell you there's nothing more anxiety-inducing than a trip to hospital when one of the little ones is ill.
Since the age of two, my son Sam has suffered from severe bouts of chronic asthma.
He developed it when we lived in Melbourne and at one point my wife and I felt the Royal Children's Hospital was like a second home.
Now returned to Sydney, Sam still frequently requires hospitalisation.
Recently he developed a bit of a cough, my wife took him to hospital and it turned out he had double walking pneumonia and a collapsed lung, on top of his asthma.
I'm always amazed by the dedication and long working hours of the nurses, doctors and support staff at the Sydney Children's Hospital, Randwick when we are there.
The level of care is second to none and despite the clear lack of resources I'm in awe of how hard the health professionals work, and thankful for the life-saving treatment provided to Sam by those professionals on a regular basis.
Start of sidebar. Skip to end of sidebar.
Related CoverageHospital reform died on the table The Australian, 1 day ago
PM warms to health fight The Australian, 1 day ago
States revolt on health plan The Australian, 7 Mar 2010
Reform vital for sick system Courier Mail, 3 Mar 2010
Better Health, Better Hospitals speech The Australian, 3 Mar 2010
.End of sidebar. Return to start of sidebar.
But despite the dedication of the nurses, doctors and staff in the hospitals, it's not hard to notice the clear lack of available resources in our public hospitals.
Many times when the doctors have admitted my son, there has been a long wait in emergency until a bed becomes available in an intensive care unit or on the wards.
On the corridors of the hospitals you can see the strain and stress in the eyes of the nurses and doctors who work so hard, and the difficulty they face in trying to find beds for critically ill children.
That's why I'm so pleased health is shaping up this year as a key federal election issue.
Prime Minister Kevin Rudd's proposed national health and hospitals network represents the most significant shake-up of our health system since the introduction of Medicare.
The proposed reforms have significant implications for the structure of our health and hospitals system.
Local hospitals will be empowered to make decisions about local health management, and hospitals will be paid directly for what they actually do.
Most significantly, it means the federal government will now take direct responsibility for the funding of our health system.
This guarantees certainty for our health system and also means the state budgets can be freed up in the future to focus on other areas that have been neglected for far too long.
Once some certainty is achieved in the NSW Budget, the state government can focus on areas such as public transport and infrastructure.
It means that we should be able to build the missing links in our road system -- like finally getting the M4 to connect western Sydney directly to the CBD and extending the light-rail network to places such as the University of NSW and Dulwich Hill.
The implications of the reforms for the people that deliver health-care services are significant.
Brett Holmes, secretary of the NSW Nurses' Association, has said that although the union is still working through the detail of the proposed reforms, it is important that the federal government becomes the central funding body for health services.
"The real issues in hospital and healthcare are funding, staffing and skill mix," he said. "The plan initially commits the federal government to 60 per cent of hospital funding and 100 per cent of primary or community health funding.
The ongoing challenge is 60 and 100 per cent of what amount?
In the end, it's real dollars, not percentages, that buy hospital and primary health care.
This is an important point. As Brett Holmes knows, at the end of the day it's the dollars that matter, which is why it's important that we examine carefully what Tony Abbott did to health funding when he was the health minister under John Howard.
Tony Abbott is running a million miles a hour away from his record of funding cuts, but the fact of the matter is that $1 billion was cut from public health funding during his time as health minister. He began by cutting $108 million in the 2003 Budget, then $172 million in 2004, $264 million in 2005 and $372 million in 2006.
Mr Abbott, the great oppositionist, is opposing the reforms. Not for long though, I imagine, because it's not a popular stance.
This week an Auspoll survey of 1000 respondents found that 76 per cent of those questioned supported Mr Rudd's plan to put the decision-making power regarding our hospitals into the hands of locals.
It also found 72 per cent wanted to see less "user-pays" health care and an increase in the proportion of government funding.
There will always be debates about the structure and delivery methods of our health system.
But we all know that we need more investment, more accountability, fewer bureaucrats and more doctors and nurses taking charge.
We need to end the state and federal blame game and this is what Labor's plan seeks to achieve.
Paul Howes is national secretary of the Australian Workers' Union
By Paul Howes
From: The Sunday Telegraph March 21, 2010 12:02PM
ANY parent with young children can tell you there's nothing more anxiety-inducing than a trip to hospital when one of the little ones is ill.
Since the age of two, my son Sam has suffered from severe bouts of chronic asthma.
He developed it when we lived in Melbourne and at one point my wife and I felt the Royal Children's Hospital was like a second home.
Now returned to Sydney, Sam still frequently requires hospitalisation.
Recently he developed a bit of a cough, my wife took him to hospital and it turned out he had double walking pneumonia and a collapsed lung, on top of his asthma.
I'm always amazed by the dedication and long working hours of the nurses, doctors and support staff at the Sydney Children's Hospital, Randwick when we are there.
The level of care is second to none and despite the clear lack of resources I'm in awe of how hard the health professionals work, and thankful for the life-saving treatment provided to Sam by those professionals on a regular basis.
Start of sidebar. Skip to end of sidebar.
Related CoverageHospital reform died on the table The Australian, 1 day ago
PM warms to health fight The Australian, 1 day ago
States revolt on health plan The Australian, 7 Mar 2010
Reform vital for sick system Courier Mail, 3 Mar 2010
Better Health, Better Hospitals speech The Australian, 3 Mar 2010
.End of sidebar. Return to start of sidebar.
But despite the dedication of the nurses, doctors and staff in the hospitals, it's not hard to notice the clear lack of available resources in our public hospitals.
Many times when the doctors have admitted my son, there has been a long wait in emergency until a bed becomes available in an intensive care unit or on the wards.
On the corridors of the hospitals you can see the strain and stress in the eyes of the nurses and doctors who work so hard, and the difficulty they face in trying to find beds for critically ill children.
That's why I'm so pleased health is shaping up this year as a key federal election issue.
Prime Minister Kevin Rudd's proposed national health and hospitals network represents the most significant shake-up of our health system since the introduction of Medicare.
The proposed reforms have significant implications for the structure of our health and hospitals system.
Local hospitals will be empowered to make decisions about local health management, and hospitals will be paid directly for what they actually do.
Most significantly, it means the federal government will now take direct responsibility for the funding of our health system.
This guarantees certainty for our health system and also means the state budgets can be freed up in the future to focus on other areas that have been neglected for far too long.
Once some certainty is achieved in the NSW Budget, the state government can focus on areas such as public transport and infrastructure.
It means that we should be able to build the missing links in our road system -- like finally getting the M4 to connect western Sydney directly to the CBD and extending the light-rail network to places such as the University of NSW and Dulwich Hill.
The implications of the reforms for the people that deliver health-care services are significant.
Brett Holmes, secretary of the NSW Nurses' Association, has said that although the union is still working through the detail of the proposed reforms, it is important that the federal government becomes the central funding body for health services.
"The real issues in hospital and healthcare are funding, staffing and skill mix," he said. "The plan initially commits the federal government to 60 per cent of hospital funding and 100 per cent of primary or community health funding.
The ongoing challenge is 60 and 100 per cent of what amount?
In the end, it's real dollars, not percentages, that buy hospital and primary health care.
This is an important point. As Brett Holmes knows, at the end of the day it's the dollars that matter, which is why it's important that we examine carefully what Tony Abbott did to health funding when he was the health minister under John Howard.
Tony Abbott is running a million miles a hour away from his record of funding cuts, but the fact of the matter is that $1 billion was cut from public health funding during his time as health minister. He began by cutting $108 million in the 2003 Budget, then $172 million in 2004, $264 million in 2005 and $372 million in 2006.
Mr Abbott, the great oppositionist, is opposing the reforms. Not for long though, I imagine, because it's not a popular stance.
This week an Auspoll survey of 1000 respondents found that 76 per cent of those questioned supported Mr Rudd's plan to put the decision-making power regarding our hospitals into the hands of locals.
It also found 72 per cent wanted to see less "user-pays" health care and an increase in the proportion of government funding.
There will always be debates about the structure and delivery methods of our health system.
But we all know that we need more investment, more accountability, fewer bureaucrats and more doctors and nurses taking charge.
We need to end the state and federal blame game and this is what Labor's plan seeks to achieve.
Paul Howes is national secretary of the Australian Workers' Union
Saturday, March 20, 2010
SWAHS STAFF SHORTAGES COMPROMISE CARE
Red News Readers,
As I understand it this area health service is almost broke!! Its good that the Nurses Association had this Rally although the numbers supporting it were disappointing, but that may reflect a number of factors – as the wards are short it is hard for nurses to get away, they may have faced intimidation from management (usual when these rallies are held), the largely overseas born staff are not used to participating in union rallies and tend to shy away from them. But what now? If the Area HealthService is broke and needs money from the State and Federal Government, it is going to take a lot more than one Rally to get that happening.
Jenny Haines
Staff shortages compromise care: nurses
LISA MARTIN, SMH
March 18, 2010
AAP
Nurses at six western Sydney hospitals claim patient care is being compromised because a lack of state funding has forced the area health service to freeze hiring.
About 700 Sydney West Area Health Service (SWAHS) nurses protested about staff shortages at Westmead, Auburn, Blacktown, Mt Druitt, Nepean, Katoomba and Lithgow hospitals during their lunch breaks on Thursday.
NSW Nurses Association general secretary Brett Holmes addressed a protest rally at Nepean Hospital in Penrith.
The health service had not advertised positions externally since February 2009 as it struggled to cut expenditure, he told AAP.
"We have got lots of vacancies in positions that aren't being filled on a permanent basis," he said.
He said at Nepean Hospital there were 20 full-time positions unfilled in the maternity section and 14.5 vacancies in the emergency department.
At Mount Druitt and Blacktown the emergency departments were short 13 nurses, and 10 mental health beds had been closed across the health service.
There was also a shortage of cleaners.
Mr Holmes said staff were worried patient care was suffering and called for a cash injection to fill the vacancies.
"The staff are feeling they're not really in a position to be providing the level of care that is required," he said.
"People get moved out of the emergency department at the start of the shift to fill vacancies in wards.
"Then when the emergency departments get busy ... it's very hard to shift them back."
Opposition health spokeswoman Jillian Skinner said the situation was unacceptable, and the nurse shortage was increasing waiting times in emergency departments and elective surgery waiting lists.
"Nurses are fed up to the back teeth," she said.
"The rally at Nepean Hospital was told there was something like 30 vacancies. It's interesting that when you go to the government's website ... they admit to only three."
"They're freezing vacancies ... so when nurses either resign, go on maternity leave ... those who remain are working even harder, and they are becoming disillusioned and they leave."
But SWAHS denied the hiring freeze.
"There is no staff freeze in Sydney West Area Health Service," it said in a statement said.
"SWAHS continues to recruit to frontline positions.
"All SWAHS hospitals have strategies in place to ensure that wards and services are appropriately staffed to maintain safety for patients and staff.
"Casual and agency staff are used as required."
The health service said its chief executive is willing to meet with the NSW Nurses Association to discuss staffing concerns.
© 2010 AAP
As I understand it this area health service is almost broke!! Its good that the Nurses Association had this Rally although the numbers supporting it were disappointing, but that may reflect a number of factors – as the wards are short it is hard for nurses to get away, they may have faced intimidation from management (usual when these rallies are held), the largely overseas born staff are not used to participating in union rallies and tend to shy away from them. But what now? If the Area HealthService is broke and needs money from the State and Federal Government, it is going to take a lot more than one Rally to get that happening.
Jenny Haines
Staff shortages compromise care: nurses
LISA MARTIN, SMH
March 18, 2010
AAP
Nurses at six western Sydney hospitals claim patient care is being compromised because a lack of state funding has forced the area health service to freeze hiring.
About 700 Sydney West Area Health Service (SWAHS) nurses protested about staff shortages at Westmead, Auburn, Blacktown, Mt Druitt, Nepean, Katoomba and Lithgow hospitals during their lunch breaks on Thursday.
NSW Nurses Association general secretary Brett Holmes addressed a protest rally at Nepean Hospital in Penrith.
The health service had not advertised positions externally since February 2009 as it struggled to cut expenditure, he told AAP.
"We have got lots of vacancies in positions that aren't being filled on a permanent basis," he said.
He said at Nepean Hospital there were 20 full-time positions unfilled in the maternity section and 14.5 vacancies in the emergency department.
At Mount Druitt and Blacktown the emergency departments were short 13 nurses, and 10 mental health beds had been closed across the health service.
There was also a shortage of cleaners.
Mr Holmes said staff were worried patient care was suffering and called for a cash injection to fill the vacancies.
"The staff are feeling they're not really in a position to be providing the level of care that is required," he said.
"People get moved out of the emergency department at the start of the shift to fill vacancies in wards.
"Then when the emergency departments get busy ... it's very hard to shift them back."
Opposition health spokeswoman Jillian Skinner said the situation was unacceptable, and the nurse shortage was increasing waiting times in emergency departments and elective surgery waiting lists.
"Nurses are fed up to the back teeth," she said.
"The rally at Nepean Hospital was told there was something like 30 vacancies. It's interesting that when you go to the government's website ... they admit to only three."
"They're freezing vacancies ... so when nurses either resign, go on maternity leave ... those who remain are working even harder, and they are becoming disillusioned and they leave."
But SWAHS denied the hiring freeze.
"There is no staff freeze in Sydney West Area Health Service," it said in a statement said.
"SWAHS continues to recruit to frontline positions.
"All SWAHS hospitals have strategies in place to ensure that wards and services are appropriately staffed to maintain safety for patients and staff.
"Casual and agency staff are used as required."
The health service said its chief executive is willing to meet with the NSW Nurses Association to discuss staffing concerns.
© 2010 AAP
Wednesday, March 03, 2010
FEDERAL FUNDING OF HEALTH
Federal takeover of health. Mr Rudd makes a bold announcement - which raises more questions than it answers. The only certainty is continuing federal under funding of hospitals for the next 4 years - or much, much longer if the states do not accept.
By Con Costa, as updated after Mr Rudd's Announcement of the Federal funding of hospitals.
On a weekend when 3 major Sydney hospitals announced downgrading of their ED services and ambulances to divert to other already overcrowded centre, Medibank Private announced its latest gimmick to attract membership – private ED service where for $195 patients could “jump the ED queue”. This comes at a time when federal share of hospital funding now down from the traditional 50/50 split with the states to an official 35%!
The public system is under increasing strain because it is becoming the default of an increasingly dysfunctional health system (including being the default for the private system). There is chronic under funding of hospitals at the federal level and the impact of federal privatisation policies on the community, health and aged care services.
Example 1. They rang me from the nursing home because the elderly woman had returned from the hospital with the intra venous line still in her arm. They had rung me several days earlier because her blood pressure was a bit high and she was complaining of headache, but despite my careful instructions over the phone they could not wait for me to arrive. The staff member on the other end of the phone had no nursing experience, and no other nursing staff available on the shift. So it was much easier to call the ambulance and send the elderly woman to hospital. Clearly both ends of the service equation were not working – and at great cost to the system.
Example 2. Across Australia millions of Australians are too often “treated” by their GP with simply a prescription, blood test or radiological investigation – again at very high cost to the system and sometimes questionable benefit to the patient. Seems its much quicker to order a simple blood test than to spend time with the patient taking a full history, perform an examination and then sit down and talk to the patient.
Thousands of men are now having a simple blood test as the sole means of assessing their prostate – called Prostatic Specific Antigen (PSA). The test is not reliable. Public authorities advise GPs against relying on this blood test as a screening test and that “its more trouble than its worth”. Nevertheless, it is now almost exclusively used by time poor Australian GPs for diagnosing prostate disease.
Patients who end up with a blood test, or some other investigation - in place of quality time spent with their GP, usually leave the doctor unhappy or are put at risk of further and more invasive investigations and treatments including referral to specialist - or they simply take themselves off to the Emergency Room at their local hospital because their problem has not been not properly dealt with or because they just get sicker.
Privatisation and economic rationales policies have strongly impacted on people’s health - to the point where GP consultations are well up. Privatisation of aged care facilities means trained nursing staff are often passed over for cheaper untrained staff. Economic rationalist policies has led to the biggest doctor shortage in Australia’s history - dating since the Productivity Commission advised the incoming Howard government in the early 1990’s along the lines that “if you cannot stop bulk billing, then less GPs would save costs through less bulk billing”.
The acute doctor shortage means that family GPs have an abundance of patients and never have to leave their medical clinic. Many sick or dying people in the community have learned to simply call an ambulance as the best way to receive care. Having a doctor visit at home, or dying peacefully at home is now rarely an option. Perfunctory medical care in the nursing homes means most end up in the hospital ED even for minor complaints. Thus the inevitable call from aged care facilities for the ambulance….
Following PM Rudds recent major statement on health it has been widely admitted that the federal share of hospital funding is now down to 35%. (Traditionally funding of our public hospitals a 50/ 50 split between the federal gvt and the states.) Mal administration of hospitals at the state level is a factor (area health boards in NSW could be somewhat reduced in size and hospital medical staff should have a greater role in regards to the planning and organization of the work they perform) - but even the best administered health board is doomed to fail while federal under funding of hospitals continues at this level – and despite Mr Rudds bold new plan, hospital federal share of hospital funding not set to increase for 3 or 4 years, and only if the states accept his new deal.
The federal government’s shirking of their fair share of public hospital funding is even more puzzling given the massive amounts of taxpayer money that the Rudd gvt has flushed through the system as a response to the GFC – including the notorious insulation program whose failure the PM partly excused based on the urgent need for the government to spend money at the time.
The Rudd government has shown little inclination to redress the real funding problems which beset the public hospital system, and this raises the worry that he is looking to more privatisation, more economc rationalist solutions for our ailing health system. Why else Christine Bennett from the private health insurance sector to lead the NHHRC? Why his quarantining of the failed 30% PHI rebate and the private walk in walk out system under which we pay our private doctors?
Yes, the recent major announcements by the PM on health financing sound bold and statesman- like. But where is the rest of the policy. You get the feeling they may be making up as they go. Or worse still that they may be holding something back which may prove the end game for the public system and introduction of a US style managed care.
The real worry may be that, under Rudd’s new new presidential style power within the Labor Party – the leader now able to hand pick his own cabinet and where Cabinet Ministers watch their own portfolios and are careful “not to tread on someone else’s turf”, there has been a tightening of the PM’s control over policy within his own Party - including greater power to his advisers and the treasury mandarins, together with his Health Minister, and the rest of the parliamentary wing no longer on watch.
The PM could do a lot worse than to immediately restore the 50/50 funding of hospitals with the states. He could set guidelines for privatised Aged Care that make it obligatory to have at least one trained nursing staff on each shift. And as an initial move away from rapid turnstile medicine in primary care, he could put all GP trainees on salaried payments – to encourage them to spend time with their patients and to provide some desperately needed house calls and nursing home care in the community. This would certainly build support for his “health reforms” with the community and the States.
Otherwise, next time you need to wait many hours to see a doctor in the public ED or you have to be transferred through busy city traffic while having your heart attack because your hospital ED has been downgraded, or your GP offers you a simple blood test instead of a quality time, or your elderly relative is yet again admitted to hospital from the nursing home for the third time in as many weeks - remember that you are not alone and it is mainly the federal under funding and economic rationalist policies which are to blame. And without something being done about that, Mr Rudd’s plans to “take over the hospital system” may be doomed from the start.
By Con Costa, as updated after Mr Rudd's Announcement of the Federal funding of hospitals.
On a weekend when 3 major Sydney hospitals announced downgrading of their ED services and ambulances to divert to other already overcrowded centre, Medibank Private announced its latest gimmick to attract membership – private ED service where for $195 patients could “jump the ED queue”. This comes at a time when federal share of hospital funding now down from the traditional 50/50 split with the states to an official 35%!
The public system is under increasing strain because it is becoming the default of an increasingly dysfunctional health system (including being the default for the private system). There is chronic under funding of hospitals at the federal level and the impact of federal privatisation policies on the community, health and aged care services.
Example 1. They rang me from the nursing home because the elderly woman had returned from the hospital with the intra venous line still in her arm. They had rung me several days earlier because her blood pressure was a bit high and she was complaining of headache, but despite my careful instructions over the phone they could not wait for me to arrive. The staff member on the other end of the phone had no nursing experience, and no other nursing staff available on the shift. So it was much easier to call the ambulance and send the elderly woman to hospital. Clearly both ends of the service equation were not working – and at great cost to the system.
Example 2. Across Australia millions of Australians are too often “treated” by their GP with simply a prescription, blood test or radiological investigation – again at very high cost to the system and sometimes questionable benefit to the patient. Seems its much quicker to order a simple blood test than to spend time with the patient taking a full history, perform an examination and then sit down and talk to the patient.
Thousands of men are now having a simple blood test as the sole means of assessing their prostate – called Prostatic Specific Antigen (PSA). The test is not reliable. Public authorities advise GPs against relying on this blood test as a screening test and that “its more trouble than its worth”. Nevertheless, it is now almost exclusively used by time poor Australian GPs for diagnosing prostate disease.
Patients who end up with a blood test, or some other investigation - in place of quality time spent with their GP, usually leave the doctor unhappy or are put at risk of further and more invasive investigations and treatments including referral to specialist - or they simply take themselves off to the Emergency Room at their local hospital because their problem has not been not properly dealt with or because they just get sicker.
Privatisation and economic rationales policies have strongly impacted on people’s health - to the point where GP consultations are well up. Privatisation of aged care facilities means trained nursing staff are often passed over for cheaper untrained staff. Economic rationalist policies has led to the biggest doctor shortage in Australia’s history - dating since the Productivity Commission advised the incoming Howard government in the early 1990’s along the lines that “if you cannot stop bulk billing, then less GPs would save costs through less bulk billing”.
The acute doctor shortage means that family GPs have an abundance of patients and never have to leave their medical clinic. Many sick or dying people in the community have learned to simply call an ambulance as the best way to receive care. Having a doctor visit at home, or dying peacefully at home is now rarely an option. Perfunctory medical care in the nursing homes means most end up in the hospital ED even for minor complaints. Thus the inevitable call from aged care facilities for the ambulance….
Following PM Rudds recent major statement on health it has been widely admitted that the federal share of hospital funding is now down to 35%. (Traditionally funding of our public hospitals a 50/ 50 split between the federal gvt and the states.) Mal administration of hospitals at the state level is a factor (area health boards in NSW could be somewhat reduced in size and hospital medical staff should have a greater role in regards to the planning and organization of the work they perform) - but even the best administered health board is doomed to fail while federal under funding of hospitals continues at this level – and despite Mr Rudds bold new plan, hospital federal share of hospital funding not set to increase for 3 or 4 years, and only if the states accept his new deal.
The federal government’s shirking of their fair share of public hospital funding is even more puzzling given the massive amounts of taxpayer money that the Rudd gvt has flushed through the system as a response to the GFC – including the notorious insulation program whose failure the PM partly excused based on the urgent need for the government to spend money at the time.
The Rudd government has shown little inclination to redress the real funding problems which beset the public hospital system, and this raises the worry that he is looking to more privatisation, more economc rationalist solutions for our ailing health system. Why else Christine Bennett from the private health insurance sector to lead the NHHRC? Why his quarantining of the failed 30% PHI rebate and the private walk in walk out system under which we pay our private doctors?
Yes, the recent major announcements by the PM on health financing sound bold and statesman- like. But where is the rest of the policy. You get the feeling they may be making up as they go. Or worse still that they may be holding something back which may prove the end game for the public system and introduction of a US style managed care.
The real worry may be that, under Rudd’s new new presidential style power within the Labor Party – the leader now able to hand pick his own cabinet and where Cabinet Ministers watch their own portfolios and are careful “not to tread on someone else’s turf”, there has been a tightening of the PM’s control over policy within his own Party - including greater power to his advisers and the treasury mandarins, together with his Health Minister, and the rest of the parliamentary wing no longer on watch.
The PM could do a lot worse than to immediately restore the 50/50 funding of hospitals with the states. He could set guidelines for privatised Aged Care that make it obligatory to have at least one trained nursing staff on each shift. And as an initial move away from rapid turnstile medicine in primary care, he could put all GP trainees on salaried payments – to encourage them to spend time with their patients and to provide some desperately needed house calls and nursing home care in the community. This would certainly build support for his “health reforms” with the community and the States.
Otherwise, next time you need to wait many hours to see a doctor in the public ED or you have to be transferred through busy city traffic while having your heart attack because your hospital ED has been downgraded, or your GP offers you a simple blood test instead of a quality time, or your elderly relative is yet again admitted to hospital from the nursing home for the third time in as many weeks - remember that you are not alone and it is mainly the federal under funding and economic rationalist policies which are to blame. And without something being done about that, Mr Rudd’s plans to “take over the hospital system” may be doomed from the start.
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