Tasmanian Times

The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. No price is too high for the privilege of owning yourself. ~ Friedrich Nietzsche

The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. No price is too high for the privilege of owning yourself. ~ Friedrich Nietzsche

Economy

The emergency in Emergency

First published March 4

Sometimes you wonder why they bother. If anyone still seriously believes the piffle on bed numbers from Health Minister Michael Ferguson will make any noticeable difference to the everlasting turmoil in emergency departments, they will soon be disabused by reality.

The new beds announced in recent days will ‒ to the extent that they actually are new and not just re-announced ‒ be filled in moments. Tasmania has about 1200 beds across the state. Using the weightings calculated by the Commonwealth Grants Commission for GST distribution, we would need an extra 200 beds to give our older, sicker poorer population the care other Australians can get. This is why they gave us an extra $251 million for health this year. But the state government has other priorities.

So, what are we getting instead of the 200 beds we need and are already paid for? The Minister said there were to be 27 new beds in Hobart, but there was no mention of the 15 beds already lost in the hospital redevelopment. So that’s 12 new beds for the whole of southern Tasmania.

But in the Royal Hobart Hospital alone, 64,000 patients presented at the Emergency Department in 2014-15. Of those, about a third ‒ around 22,000 ‒ needed to be admitted to a ward for specialist care. On average, each inpatient stays in hospital for three days, so that’s 66,000 patient days just from emergency.

This accounts, though, for only one in three of all inpatients treated in that hospital: the majority are referred by their doctors. So 12 beds ‒ or 27, if you believe the minister ‒ won’t make much difference to emergency department waiting times. Any improvement won’t last for long.

For the Launceston General, “15 more permanent beds” were announced. But 12 of these are already in use. Their description has been changed ‒ from “temporary” to “permanent” ‒ but that’s all. There will be three new single rooms for vulnerable patients but these have been planned for some time.

At the North-West Regional Hospital in Burnie, eight new beds were announced. The trick here is that only four are for inpatients: the rest are merely an extension of the emergency department. That’s where patients will be kept when they need an acute bed but can’t be moved to one because those are all full. They will not relieve bed block or the workload in emergency. Only acute beds on specialist wards can do that, but they cost money.

According to the accepted measure of bed block, the situation is twice as bad in Tasmanian public hospitals as in the rest of the country. For people needing to be admitted from emergency, those at the 90th percentile ‒ 10% have to wait this long or longer ‒ have to wait for 19 hours and 24 minutes, against 10 hours and 43 minutes for the country as a whole. It’s bad everywhere but it’s worse here.

That has well-documented dangers. A large body of research has shown that people affected by bed block for eight hours or more are between 20% and 30% more likely to die. That means someone with a 30% risk of death when they come through the door have that risk elevated to 36% to 40% if they can’t get a bed.

Research for the Australasian College of Emergency Medicine estimated that the national death toll from bed block exceeded the road toll. In Tasmania, we can expect it is likely to cost twice as many lives as road accidents. And that’s likely to be a conservative estimate because bed block has been getting worse and the road toll has been getting better.

Three media releases were issued by Mr Ferguson on bed numbers. In each you will find this sentence, which is worth our attention: “We have made a record $6.4 billion investment in our health system over the next four years, and while there is still more to be done we are delivering the health system that Tasmanians need and deserve.”

That “record investment” disappears when you take the figure apart. It is achieved only by including everything, not just what the state government puts in from its own resources. In this total is all the funding received by the Commonwealth, which includes 43% of the cost of treating every patient. It includes the federal funding for the Mersey Hospital. It includes all the money being spent on the Royal Hobart Hospital redevelopment, including the Commonwealth’s contribution of about half the cost of that project. The redevelopment, of course, will be over in another three years. And it includes the money public hospitals raise from charging patients.

In 2013-14, 23% of patients at the Royal Hobart Hospital were treated as private patients, paying through their health insurance. The figure was 17% at Launceston and 11% at Burnie. These figures have been going up each year.

The $6.4 billion includes the dispensing fees that outpatients pay to outpatient pharmacies ‒ $38.80 for each drug if you don’t have a concession card. This is a state charge, not a federal one. And it includes the money raised from patient’s workers’ compensation and accident insurance. All up, the state government raised $82 million in 2014-15 alone from these patient charges.

A more revealing look at the state government’s attitude to public hospitals is found in recurrent funding ‒ that is, the amount given to hospitals day-to-day running, paying staff and treating patients. In dollar terms, that will rise by only 3.1% over the whole four years, falling short of actual costs by about 30%. Between this year and next, recurrent hospital funding will actually fall by $6 million.

This year, the amount set aside in the state budget for running emergency departments fell by 5.7%.

This is what is known as delivering the health care system that Tasmanians need and deserve.

*Martyn Goddard is a Hobart-based policy analyst specialising in health issues. He is a former journalist and ABC documentary maker who became involved in health policy during the AIDS crisis in Sydney. Since then he has been a member of the main Commonwealth advisory bodies on AIDS and hepatitis and was the first consumer member of the committee that lists drugs on the PBS. He was also health policy officer for the Australian Consumers’ Association. For the past decade he has concentrated on examining and explaining Tasmania’s health issues.

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29 Comments

29 Comments

  1. Leveller

    March 12, 2017 at 3:37 pm

    Why do they keep employing dead-wood Health Department bureaucrat’s from anywhere else but home here in Tasmania? Haven’t they learn’t from the last New Zealand experience? (anonymous comment deleted)

  2. Martyn Goddard

    March 9, 2017 at 5:47 pm

    Re #23: Yes, that is what the short-stay beds are designed for, not people who need to be admitted. As it happens, I recently occupied one myself in emergency at the RHH. But when patients can’t get from emergency into a specialist ward, this is where they will be kept: it will be quieter, less busy and a bit more comfortable, but these patients will still not be getting the specialist clinical care they need.

  3. Simon Warriner

    March 7, 2017 at 7:09 pm

    re 25, a better question is how would what I am proposing actually make things worse? As for explaining for your level of comprehension, I am not a miracle worker. Sorry.

    26, Geoff, no worries. Perhaps the way to see how what I am proposing could work is to imagine the people standing as independent elected representatives behaved more like we seem to expect our sporting representatives to behave and less like our party politicians currently do.

  4. Geoff Couser

    March 7, 2017 at 12:50 pm

    Re #22

    Thanks Simon…and apologies for virtually hijacking a very important post about a subject dear to me (as an emergency physician at RHH)…this probably deserves its own thread….

    You’ve talked of this concept for a long time, I’m not really arguing with you, I just find it difficult to comprehend how it wouldn’t morph into what you’re opposing…humans being humans and all….my point is that we all need to get involved in the body politic to ensure better outcomes, debate and discussion…for the good of all. Many different vehicles to achieve that….

  5. TGC

    March 7, 2017 at 11:26 am

    I agree with the ‘hurdles’ raised at #21- and absolutely confused by the ‘solutions’ at #22
    That contributors offer to “try again” should be welcomed and especially explain how the ‘alternatives’ suggested in #22 will make any outcome ‘better’ than what is currebtly in place.
    I notice Nick X. is forming a new ‘Party’ (Of ‘Independents’?) to contest elections (in South Australia) and some of his comments so far suggest he is as confused as is #22.
    Given that Nick negan his politcal ‘career’ calling for an end to some forms of (or all?) gambling in SA he hasn’t had that much success.
    But he has confounded the Nation.

  6. Barb Baker

    March 7, 2017 at 11:24 am

    Good to see that Michael has read Martyn’s article

  7. Michael

    March 7, 2017 at 10:12 am

    I would like to correct an error in your article. The Short Stay beds added to the ED at the North West Regional Hospital are ABSOLUTELY NOT for people who need a hospital bed but there isn’t one for them to go to. The Short Stay Unit is for patients the Emergency doctors believe need a period of observation or treatment less than 24 hours and are unlikely to need a longer admission. This is a facility that is widely used by EDs around the world but has not previously been available at the NWRH.

    It is important to ensure factual accuracy in your articles, otherwise you risk undermining your otherwise valid points.

    Michael.

  8. Simon Warriner

    March 7, 2017 at 12:16 am

    Geoff, thank for the interest but nope, the last thing I am suggesting is another bloody party.

    More than the individuals involved, that structure is the problem, in the same way as scrubby little gullies attract snakes. And yes, I have been watching those you mentioned with considerable interest.

    What I am suggesting is an organisation that has as its mission the promotion of a public conversation about the flaws in the party political system and the way in which independent representatives can help to repair the damage those flaws are allowing to happen. That conversation does not need to dictate policy, set agenda, or promote ideology. What it could do is discuss the role of an elected representative, discuss the attributes that might help an elected representative perform that role, and develop resources that help level the playing field toward the independent representative candidate. those resources could include training, information, and provision of access to specialists to help candidates understand issues.

    No running candidates, no handing out how to vote stuff, no participating in policy debate. Discussions about the manner in which government is done is within it’s remit, but only to the extent that it contrasts those issues that involve party political support for party politicians over independent representatives.

    Individuals associated with the organisation might have personal views, in fact I would be amazed if they did not, and would be free to express those views as they see fit, but not to represent those views while representing the organisation.

    What seems hard for people to get their heads around is that such an organisation stands to gain precisely nothing out of the exercise except the honor and dignity of providing a community service. It might garner some moral standing, it will certainly garner some fairly nasty critique from the party tribe, and it will be hard work.

    It stands in stark contrast to much of what is passed off as public service by our political parties when they pat themselves on the back.

    The problem with entering the parliament with your policy set down prior is that reality gets in the road and the ego involved in power structures makes it impossible for the personalities involved to compromise and co-operate. We see it repeatedly and it delivers nothing useful. Ever!

    What I suggest is that the game be changed to one where the skill set is firstly representational, then collaborative. Rather than policy being determined from a single, often very narrow perspective, allow the broadest possible perspectives in defining the problem and designing the solutions. That way implementation is much more likely to be supported widely and succeed. Better that than to declare competing solutions and then fight it out in that disgusting farce we call politics, and blame the opposition when the implementation fails, as it does repeatedly.

    I hope this helps. If not let me know and I will try again when i am not so tired.

    Cheers

    Simon

  9. Geoff Couser

    March 6, 2017 at 7:52 pm

    Re #19

    I see where you’re coming from, I really do. But do you see the inherent contradiction in both bemoaning party politics and then calling for an “organisation….to promote the value of independence, intelligence and integrity…”?? Sounds like a party to me…

    I think whether you like it or not, the key to all this is good people getting involved and developing policies and ideas and then having the courage and drive to stand for parliament. That may well mean political parties. If not parties, note how many independent groups are coalescing into parties? NXT, One Nation, Clive Palmer, Jacque Lambie…how are they going??

  10. TGC

    March 5, 2017 at 10:15 pm

    #19 appears to be wanting the ‘independents’ he has in mind kept from public scrutiny – but at some stage they will need to ‘nominate’ for election and then be prepared for ‘cross examination’- sometimes more ‘cross’ than ‘examine’
    But,an explanation is required of “Imagine what fun could be had if an organisation was formed just to promote the value of independence, intelligence and integrity as attributes of our elected representatives.” “Fun” may be ‘fun’ but government ought to be considered a serious business-which is probably why it attracts the comments often appearing in TT because ‘poking fun’ is a way for contributors to hide their overall ignorance of the process and responsibility of ‘governing’

  11. Simon Warriner

    March 5, 2017 at 5:05 pm

    re 17, at the risk of encouraging your continued journey to irrelevance, I do not see “dozens” of potential electoral representatives of the type I am encouraging posting on TT. I see somewhat less than 10, and no, I will not be naming them, ever. Many here are still struggling to put ego and ideology aside and recognise that pursuit of the wider common good means that their pet whatever might just have to miss out. There is also a clear difficulty understanding that their ideas for fixing the “system” (for want of a better description) have less than a snowballs in hell of seeing implementation while ever party politics dominates our system of government. They need to come to terms with the simple fact that implementation requires a house of assembly prepared to consider ideas from outside its own reference group. One dominated by party politics won’t.

    Would I stand for election? I honestly don’t know. Right now I would not because family circumstances weigh against it, but next time around I could see myself giving it serious consideration but things might change. Right now my objective is to plant and water as many seeds as possible. That project is going somewhat better than expected given the effort expended, and the endless displays of ineptitude, stupidity, greed and outright arrogance from the party performers have been no end of help. Imagine what fun could be had if an organisation was formed just to promote the value of independence, intelligence and integrity as attributes of our elected representatives. With the sort of material party politics provides to work with, writing ads would be pure comedy.

    Actually, I must thank you, the exercise of writing this response just caused a name I have been searching for to pop to the surface.

    Cheers

    Simon.

  12. Martyn Goddard

    March 5, 2017 at 1:53 pm

    Re # 13: For the record, I accept no payment for my work and have not done so since I retired from the Australian Consumers’ Association in 2004. I have no alliance of any kind with the AMA or the ANMF. I value my independence.

    The data very clearly show Tasmania could afford a health system which is at least on a par with those in other states. We can afford (and are already being paid for) those 200 extra beds. Although all state and territory budgets will be unable to cope with longer-term rises in health costs without more Commonwealth help, Australia as a nation can well afford a vastly better (and more efficient) system than we have.

  13. TGC

    March 5, 2017 at 11:24 am

    #15 Do you have some evidence that “… the market (is not) open(ed) to those possessing some measure of integrity, independence, or intelligence.”?
    From what appears on TT there are dozens of so qualified to bring the result #5 appears to be seeking- and some of those would – as I understand them- do the job for nothing.
    Of course, not all of them- even any of them- would agree with each other across the range of ‘portfolio’ issues so there could be some difficulties there. But, because they would have
    those qualities of “integrity, independence, or
    intelligence” _(but not all three together apparently) they would quickly form into a wonderful parliamentary power-doing the job better, more cheaply and for longer hours.

  14. Angela Cooper

    March 5, 2017 at 3:25 am

    What about mental health beds? Bed block is a common occurrence. The mental health beds are just that, Mental Health beds. They are being used too frequently for drug and alcohol patients and homeless people. We need more beds in the community for people with Drug and Alcohol issues as the public health system is being drained because there are not enough detox and drug and alcohol beds and the Royal Hobart Hospital is NOT a Detoxification centre, nor is it a homeless shelter! There needs to be more a huge funding injection into these two issues!

  15. john hayward

    March 4, 2017 at 11:39 pm

    #12, TGC. The difference between 5 and 6 might seem a petty gradation in the Ex’s order of journalistic exactitude, but it can matter.

    I suspect #5 was merely suggesting that our LibLabs may not represent the optimal quality potentially available at 133.5K+ p.a., for the shortest working hours in the parliamentary country, if the market were opened to those possessing some measure of integrity, independence, or intelligence.

    John Hayward

  16. Don't Be a Tasmanian

    March 4, 2017 at 8:18 pm

    They say they have given Tasmanians the health system they deserve …

    They have provided the drinking water Tasmanians deserve …

    They have provided the electricity price increases Tasmanians deserve …

    They have provided the high standard of environmental protection that Tasmanians deserve …

    Clearly, they don’t think much of Tasmanians …

    Perhaps we could have more beds if they sacked all the spin doctors.

  17. Verdun Mokbell

    March 4, 2017 at 6:21 pm

    Good old Martyn Goddard still earning a living saying “its never been this bad in health”. Mana from heaven for Australia’s strongest union – the AMA as well as Nerolli Ellis and the ANF. Fact is no Government could ever provide a big enough health budget to satisfy these whingers

  18. TGC

    March 4, 2017 at 12:05 pm

    #6 “Only when independent minded individuals, whose only allegiance is to their constituents and the common good of all Tasmanians, are put into parliament and given oversight of the swamp critters and allowed to expose and eliminate the nepotism, bullying, rorting and dishonesty will things improve…”
    Other than ‘himself’ who does #6 have in mind? and have they showed both a willingness to take on these roles and a capacity to perform them?
    Names must be named to give the electorate time to absorb the options before the next election.

  19. Barb Baker

    March 4, 2017 at 12:40 am

    Totally agree Martyn. Political spin and carelessness with the truth regarding health issues is what we have come to expect from The Minister.

  20. john hayward

    March 4, 2017 at 12:27 am

    Martyn appears to have no empathy for the pain felt by a god-fearing Liberal minister pressured to expend substantial amounts of public funds on people who have no inclination of returning any portion of it to himself or his party.

    John Hayward

  21. TGC

    March 3, 2017 at 5:58 pm

    There may be many things that contribute to Tasmania’s budgetary concerns insofar as these impact on health and education- but high amongst them is our concentratrion on tourism
    Whilst this industry benefits the players- particularly at the top end- it’s cash contributiun to the State income is at best modest and more likely fairly trivial.
    And if it is to be called an ‘industry – as it is- then it’s fair to draw comparisons between it and ‘heavy’ industry- on which Tasmania once relied but Green snobs have gradually driven it either out or under.
    At local and ‘individual’ level tourism may keep family and even small group business going but the net return to them is such that their contribution to State income is neglible. (the late Eric Reece had it right about this ‘industry’ year’s ag)
    Chanting “a million tourists” doesn’t translate into hospital beds/nurse/surgeons etc nor school teachers and associated matters.
    A radical re-think is needed if Tasmania is to meet the challnges thrown up by an ageing demographic and a declining income base.

  22. Chris

    March 3, 2017 at 5:10 pm

    You have pneumonia, we will put you in that bed over there until we can find a bed in the hospital.
    Time moves on…
    We have found you a bed in the cancer ward, no possibility of infection there, its like a Ferguson smile, all grin and no content.
    Can you count…
    Ah well there are extra beds taken from the total and put into the system before they are allocated to increase the number available from the reductions.
    Yes Minister.
    Goody goody Mr Rockcliff is preparing to take over from Wee Willy who still advocates the leaders (Erica Betz) policies and has fallen into disfavour.
    Ministerial portfolios will go to the likes of the Grinner and the Spoker along with a stout business men as soon as alimony is paid .
    Fergie’s Son will be made speaker as he can spin on a sixpence and enhance Gut Whiners economics, “Sack and save”, and like a constipated accountant he works it out with a pencil on an envelope.

  23. Robert LePage

    March 3, 2017 at 3:29 pm

    Recently in all seriousness the State government came out with a proposal for building a cable car to the summit of Mt Wellington.
    Where the money for this was to come from was left a bit vague. When you see the horrific conditions in the only public hospitals in Tasmania, it beggars belief that this should be even be considered.
    Unfortunately all of the political parties are absent from duty on this.
    It is going to make no difference when Labor wins at the next election they will continue on the same path as they did when they were last in power.
    Maybe we should all throw our weight behind Pauline Hanson if she were to sign a legal agreement to spend the millions needed to put the health service on a stable footing.
    In the meantime, do not get sick or old in Tasmania.

  24. Nigel Crisp

    March 3, 2017 at 1:28 pm

    What makes steam come out my ears is when we hear yet another entrepreneur trying to get a leg-up from taxpayers’ dollars.
    In the Mercury today (4th March, pgs 4 & 5) the Baillie family are in discussions with the Libs for some incentive to proceed with the Eco Lodge at Crescent Bay.
    This when Health Care in our state & the hospital is screaming out for funds !
    Then of course it’ll be a commercial in confidence deal on our coin.
    I’d like to swear, but it changes nothing.

  25. Simon Warriner

    March 3, 2017 at 1:23 pm

    As long as we keep putting party politicians into parliament we will keep on living with the stench of the gangrenous mess that hides under the public health bandaid.

    As long as those same politicians are able to access private health insurance and remain insulated from the consequences of allowing the public service bureaucrats to continue their less than competent management of the system that gangrenous stench will never get removed.

    Only when independent minded individuals, whose only allegiance is to their constituents and the common good of all Tasmanians, are put into parliament and given oversight of the swamp critters and allowed to expose and eliminate the nepotism, bullying, rorting and dishonesty will things improve. Health is hardly alone among the government organs in this respect, but its presence in that service is literally life threatening.

    As any good health professional knows, you deal with the environmental factors to gain the greatest benefit for the greatest number rather than treating symptoms in individual patients, if you want to really improve the health of a population.

    Our approach to politics is THE health issue. We can fix it by changing the type of people we put into parliament.

    Problems are never fixed by the same thinking that created them.

  26. Catherine

    March 3, 2017 at 11:31 am

    Smoke & mirrors, you’ve got to hand it to them. They can spin anything, if they gave you a pile of dog poo they would convince some people it was chocolate.

  27. paul tapp

    March 3, 2017 at 11:28 am

    Good to know that someone with the expertise of Martyn is onto it. A journo who knows not just the industry but the politics behind it plays an invaluable role in keeping the public up to scratch on perhaps the most important issue in the lives of an ageing population…health care. Martyn’s research shows stats that really translate as money-grabbing by the State government and it’s nigh time they put health care revenue back into health care. The smile on the face of the Minister’s PR photo shows he thinks he’s getting away with the smoke and mirrors health-care show, so it’s nice to get an insight from MG, that he isn’t going to.

  28. Alison Bleaney

    March 3, 2017 at 10:23 am

    Thank you Martyn for laying these issues out so clearly.
    I fear that Tasmanian health strategies are not about to change and that the deck chairs are just being moved about on the deck of the sinking ship….as a health professional having worked here for nearly 30 years and still living in Tasmania it is painful and confronting to watch and see the results of inadequate care dished out by the ‘system’. No amount of talking, submission writing, networking…anything…by Tasmanian health workers has changed anything (perhaps the speed of the ship on the way to its own disaster but not the course set).

  29. phill Parsons

    March 3, 2017 at 9:42 am

    With the State at or near the bottom for a range of social indicators including those impacting on health such as income, education level, smoking rates, obesity and salt intake along with an ageing population it would seem to me that the health system/industry will never catch its tail.

    To expect people to change their learned and ingrained behaviors is a big ask requiring massive campaigning and the alternation of generations.

    Good luck with that.

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