‘Crumbling’ health system a taste of future collapse

4 minute read

The AMA (NSW) has weighed in on the latest hospital stats from the NSW Bureau of Health Information.

The NSW Bureau of Health Information quarterly report on the state’s “crumbling” health system suggests the state will have an even more broken system if nothing is done to address the disconnect between primary care and hospital services, says AMA (NSW) president Dr Michael Bonning.

The BHI quarterly figures, taking in the period from 1 October – 31 December 2023, showed record demand on the state’s health system.

“What we are seeing are seeing visions of a future, where our needs and changes to our health system have to bring it into line with the burden of illness that we are seeing,” he told TMR.

“The data shows that our health system is being challenged by the ongoing change in the health status of our community.

“And then people who need hospitalisation, they are becoming more complex, because they’re living longer and often better lives. But those better lives also include management of chronic disease.

“Chronic disease doesn’t care where the funding comes from, and who manages it, it acts in response to people’s basic physiology and environment. And therefore, we need to respect that and put care where care is needed.

“I think you do that by building those partnerships [between primary care and hospitals] and building interoperability so that we can use our resources to the best of their ability. It’s really important that we’re good stewards of our resources in the health system so that everyone can get it can get what is needed for them at the time.”

The report revealed ambulance activity was higher than any quarter since the BHI began reporting in 2010 at 379,705 responses including a record 14,741 “highest priority – P1A” responses for patients with a life-threatening condition, up 34.8% (3804) from the same quarter the previous year.

There were 798,813 ED attendances, up from 790,309 in the same period last year, and up 2.9% on pre-pandemic levels. EDs continued to see more of the most urgent patients with 6649 triage 1 presentations and 119,389 triage 2 presentations – both the highest of any quarter since BHI started reporting in 2010.

While 58.1% of patients spent less than four hours in the ED, a slight improvement on the record low in the preceding quarter, one in 10 patients spent longer than 10 hours 30 minutes in the ED – well above pre-pandemic levels.

There were 497, 870 admitted patient episodes – up 4.6% (21,838) from the same quarter the previous year. There were 230,643 acute same day patient episodes – the largest increase (5.9%) in type of care compared to pre-pandemic levels.

The average length of stay for overnight non-acute episodes (planned hospital stays) was 16.7 days, 12.8% higher than pre-pandemic levels.

Dr Bonning said these results highlighted the critical condition of the state’s health system and the desperate need for an injection of health dollars – and that they should also be a “wakeup call for the NSW government”.

“The health system is crumbling under unprecedented demand, while staff try to manage after funding cuts delivered in the Minns government first budget,” he said.

“The September budget delivered a measly 0.87% increase, which after being swallowed by health inflation, estimated at 8%, is a 7% budget cut.”

Dr Bonning called on the Minns government to commit to a substantial increase in health funding in the upcoming budget, as outlined in the AMA (NSW) pre-budget submission.

“Our drastically overburdened health workforce cannot continue to perform under the current conditions,” he said.

“Without an urgent injection of health dollars, it is patients who will suffer as they wait longer in the emergency department and are forced to endure longer stays in hospital.”

Dr Bonning said the pressure on the hospital system was untenable, but much of this could be relieved with better-supported programs and services outside the hospital settings. Examples of this include virtual care models, chronic disease management programs run through primary care settings and better pathways for older patients to access aged care.

“The hospital is really important for the delivery of the surgical services, but beyond that, we can use other environments to support the post-surgical care, and the rehabilitation of the patient doesn’t necessarily have to be in hospital,” he said.

“Part of it is about community organisations being linked to patients when they are in hospitals so there can be a seamless transition when they leave.”

Better communication when discharging patients would also go a long way, he said.

“It doesn’t need anything super complex,” he said.

“I would happily take a secure email to the practice, I would happily take a quick call to the practice staff that just tells us that a patient has been discharged.

“And then we’ve got an opportunity to make space for the patient to see their GP. And then everyone actually works together.”

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