Same solutions to old problems

As I write this column, the NSW Government has just announced its first post-election Budget. Despite the largest revenue writedown in NSW history, the state will be $802m in the black.

It’s a relief to see the Government is boosting front line workers over the next four years, including 3300 more doctors and health professionals. As this edition of The NSW Doctor details, the public health system – particularly its psychiatry workforce – is in desperate need of greater resourcing. I note, however, that despite leading psychiatrists warning we have passed the tipping point, there has been no major financial boost to provide care for people with severe psychiatric conditions (severe depression, psychosis, schizophrenia, etc) in public hospitals.

The increase in mental health patients presenting to emergency departments is exasperating the situation in our already overstretched EDs. Our emergency departments are overcrowded. The latest Bureau of Health Information report revealed there has been more than a 40% increase in the number of patients presenting at NSW emergency departments, in less than 10 years. We’ve just witnessed another all-time record for ED presentations, peaking above 750,000 patients for the first time.

This is not just a reflection of population growth. It also speaks to the rising prevalence of chronic disease and our inability to effectively manage these conditions in the community. If we can treat people at the primary care level, then we can keep them out of hospital and relieve some of the pressure in emergency departments.

We will never be able to build big enough hospitals and emergency departments to deal with this crisis. Unless we can successfully target both the demand and supply problems facing our hospitals, issues of overcrowding that plague both the patient and staff experience will not go away.

Instead we need to think about tackling these issues in a different way. We must refocus our efforts on primary care and helping people better maintain their health before their condition becomes dire.

The State’s commitment to reducing overweight and obesity fits into this paradigm shift. The Government’s commitment to planning for additional greenspace throughout Sydney, an increase in trees for better air quality, and investment in public transport are good incentives to encourage people to be more physically active.

Expanding the Active Kids program from a single $100 voucher for children to participate in organised sport to two vouchers is also a positive move in terms of the Premier’s priorities on childhood obesity.

In addition, I applaud the boost to frontline services staff which will place 100 additional counsellors or psychologists in schools, as well as a $70 million investment into mobile dental clinics at schools in western Sydney, the Central coast and the Mid-North coast. There is also $76 million to increase elective surgery in hospitals, with children given preference. The goal of this funding is to increase paediatric surgeries by 8,000 over four years. This focus on children will pay dividends.

But the State can’t tackle preventative health on its own – particularly given the Federal Government has much greater control of primary care. This Budget really highlights the need for better coordination with the Commonwealth.

It also highlights the need to boost total spending on primary care to 10%. With this goal in mind, we will continue to push the Federal Government to increase total spending on primary care to 10% of the total health Budget. It’s time for 10.