Improving Public Hospitals

During a week in which our NSW public hospitals are the hosts of both a new intake of interns, and an even larger group of Junior Medical Officers who have just stepped up a level in seniority, we hear from Canberra that the Coalition Government has refused to commit to an increase in its existing share of growth funding to public hospitals above 45%.

Large numbers are being thrown around about money on its way to the States for public hospitals, and our own State Government has seemingly been talked into accepting the initial offer. However, when you consider that the Western Sydney Local Health District’s expenditure for 2016-17 was $1.7 billion alone, the increase of $8 billion per annum for the whole State does not look quite so generous.

Political leaders love to talk about our “world class” health system and public hospitals. This is partly to reassure the general public, and in many ways it is true. However, it also allows a degree of complacency. As a doctor within the public hospital system for three decades, I remain frustrated by so many structural barriers to patient safety and quality of care, and by so many factors preventing our truly talented and dedicated clinical staff from performing at their capacity.

In my mind, I envision a future where public hospitals, in our affluent and well educated nation, are able to achieve many things. Patients will be equal partners in their care, empowered to question decisions being made about their treatment, with ready access to their electronic medical records to check for accuracy and progress. Communication will be clear and consistent. They will be kept safe with well-maintained and functional equipment in an environment that is built to prevent infection transmission and falls. When they present to hospital, the doctors and nurses will have immediate access to key information about their medical history from their community general practitioners and specialists, as well as pathology and imaging results. When they are discharged, those records will be updated accurately, with clear goals for management. If the patient needs support in the community, the NDIS will promptly assess the patient and provide necessary equipment, and community health services will be in a position to provide ongoing support.

In my ideal public hospital of the future, medical staff will be working in environments in which they are not only appropriately trained and qualified, but feel that they are safe and well supported, and free from harassment. This system will not switch over nearly all of its junior medical workforce in a two-week period early in the calendar year. (Because that would be dangerous, wouldn’t it? Imagine an airline that crewed a passenger flight with nearly all flight staff who were new to their job at the same time.)

The senior medical staff in my future hospital will be able to take their leave entitlements without their colleagues having to do an extra person’s work to cover. They will not be made to feel guilty about having children, or needing time off for their own health reasons, or for even having a holiday. They will work in a system flexible enough to allow them to see urgent cases in outpatient settings without placing further burden on already crowded emergency departments.

In the future, acutely ill mental health patients will be afforded the dignity of being transferred to an appropriate bed in a mental health ward without having to wait days in a cubicle in the ED, and elderly people will no longer be seen as the lowest priority to be assessed and transferred. Futile therapy will no longer be offered to people in whom neither quality, nor duration, of life was likely to be improved. Furthermore, the standard of treatment offered and access to these services will be much more consistent across our State, and much less dependent on the income level of the town in which you live.

The bottom line is that we still have a lot of work to do in our public hospital system. Achieving sustained improvement will not occur by driving the staff and the system even harder than they are already being driven. Inefficiencies that exist are not due to lack of effort or dedication by clinical staff. Clear, innovative strategic vision and leadership, and a healthy injection of money is what is needed to achieve the future I have outlined. Activity is not the same thing as progress.