President’s Word March / April 2017

A new Premier and a new Health Minister in NSW offers a chance for the Government to do a stocktake on health and set some new directions. We have seen a period of investment in infrastructure which has been welcome and necessary, and building new hospitals needs to continue. We have also seen relentless pressure on hospital administrators to achieve efficiency gains, especially in emergency departments. Pressure on administrators, of course, translates to pressure on clinicians to deliver more for less. Despite all of this focus, even to the point of emergency department waiting times being one of the former Premier’s priorities, improvements in performance have been modest. This is very enlightening, but should also give cause for reflection.

NSW public hospitals are, by any standards, very efficient places. Unfortunately, demand for both emergency care and elective surgery continues to grow at higher than anticipated rates. The reasons for this are unclear, and not explained by population growth alone. I suspect the Medicare rebate freeze is really biting, with access to general practice becoming more difficult, especially after hours. A patient seeing their GP early in the course of an illness is the best way to prevent that illness becoming worse. Avoiding the GP, for whatever reason, runs the risk of the illness progressing to the point of requiring hospital care. The Commonwealth is probably content to continue to underfund general practice and shift the cost to state hospitals, but it ends up costing the taxpayer much more overall. More importantly, it is bad for patients.

The other cost of the relentless pressure on public hospitals is the human one. I am increasingly concerned about the effect this pressure is having on both medical and non-medical colleagues who seem to spend more of their time on administrative functions, and by consequence are always rushing to get their patient care, teaching and training roles covered. Most people I know spend a lot of time at night and on weekends preparing talks, answering emails, and getting their research and other academic activities done. As a profession, we are at risk of large scale burn-out. I also hear a lot from colleagues that, although the vast majority of patients are very grateful for the care they receive, some are very quick to complain if they feel an outcome is less than perfect. Given the importance we all place on doing our best for every patient, this can be very distressing.

So, perhaps our new Health Minister will be persuaded that the best investment in health is in the human resources that keep our hospitals and public health services running at such high standards, and that it is time, once again, to look at how well those resources are distributed across our State, how accessible care close to home is for our patients, and how we can best use technology to modernise and improve healthcare.

While we are on the topic of new Health Ministers, it is disappointing that our new Federal Minister Greg Hunt has dismissed the idea of a tax on sugar-sweetened beverages so early in his tenure, despite an increasing number of experts in the field calling for it as part of a strategy to address Australia’s epidemic of obesity and overweight. Similarly, the Minister for Rural Health, our own colleague Dr David Gillespie, would also have us believe that this is simply a matter of personal responsibility. Gentlemen, the personal responsibility approach is clearly failing, and it’s failing under your watch. If we, as a society, had taken a similar flat-earth approach to tobacco control, we wouldn’t have tobacco use levels close to the lowest in the world.

The Federal Coalition’s obesity strategy, and it’s whole public health agenda, is in need of a major reworking. AMA would be happy to help, Minister Hunt.