A record number of patients wait in our EDs. Can NSW’s hospital crisis be solved?

Independent Wagga Wagga MP Joe McGirr, who was an emergency physician and a hospital administrator, says greater gains will be made in making it affordable to visit the GP.

In May, the federal government attempted to ease upward pressure on the cost of visiting the doctor by tripling the bulk billing incentive given to GPs. There was a freeze on indexing of Medicare rebates from 2014 to 2020, which put practices under pressure as it became increasingly difficult to bulk-bill patients and make a living.

“There are a lot of people with chronic illness … those people need to see a doctor who’s going to care for them regularly,” McGirr says. “If they do, they will prevent admissions to the hospital.”

AMA NSW president Dr Michael Bonning says getting on top of elective surgery waiting lists would help alleviate emergency congestion. “We should also be urgently looking at a greater focus on preventative health, for example, a tax on sugary drinks, or on implementing laws to curb vaping. The aim is not to tell people what to do but to make their life easier by keeping them healthy,” he said.

Elective surgery waiting lists

On his first official day as health minister, Park announced a task force to tackle the state’s elective surgery waiting lists. At the time, more than 14,000 people were waiting longer than clinically recommended for surgery. That figure dropped to 9176 in June, the minister’s office says, less than half of the peak of 18,748 people at this time last year. As at December 31, 2019 – before the pandemic – the waiting list sat at 1144 patients. It remains eight times higher now.

The waiting list was trending downwards before the new government was sworn in – but Park has indicated it is one of his key priorities.

“Those are people who are often living in pain, unable to work, unable to often engage with things that we take for granted in life,” Park says. “The task force stays in place, until I’m happy that each local health district understands that this is a priority.”

Since the onset of the pandemic, the number of elective surgeries contracted to private hospitals has ballooned from about 200 to more than 5000. That means almost 10 per cent of elective surgeries performed in NSW are now conducted in private hospitals, at significant cost to the taxpayer.

Staffing shortages

The blow-out in emergency waiting times can be, in part, attributed to short staffing, something Park concedes. Heading into the state election, Labor promised to employ a further 1200 nurses to ensure so-called “safe staffing levels”.

Park told the Herald this promise would come through in the September budget. But he could not promise the new nursing positions would be in addition to the state’s 1112 temporary nurse contracts, being made permanent, only that he would “advocate” for them.

At the end of 2012, 42,243 full-time nursing positions were held in the state. As at June 2022, that number had grown to 53,129 and, while it is an increase, the nurses’ union argues that it does not trend with hospital demand.

On Friday, Health Service Union boss Gerard Hayes announced the HSU would resume industrial action next week despite members narrowly voting in favour of a flat rate $3500 pay rise offered by the Minns government.

The HSU has warned the government that workers are fleeing to Queensland, the ACT and Victoria because the pay is significantly better and housing is cheaper. Nurse unit managers in Victoria, for example, earn $1.50 an hour more than their NSW counterparts.

Australian Paramedics Association NSW secretary Alan O’Riordan says other states are poaching paramedics with higher wages and bonuses up to $20,000.

“It’s no wonder we’re seeing a mass exodus of great clinicians,” he says.

Health spending

In February, Labor said it would set up a royal commission-style inquiry to investigate health’s $33.5 billion annual budget. Health usually receives the biggest chunk of change each year, ahead of education, which holds a $22 billion budget.

Park says Labor is committed to the inquiry. “You definitely [will] have the terms of reference out there before the end of this year. I just haven’t set one up before. So, I just don’t know how quick they go.”

Part of the inquiry will be to examine the use of private recruitment firms to plug holes in the health system and other spending inefficiencies, such as the $40 million spent on private security contracts at western Sydney hospitals between 2020 and October last year. It is spending that Park admits “is completely unsustainable”. But outsourcing elective surgeries to the private system, he says, will continue.

“There is a price, and that price is not cheap,” he says. “But it is necessary, at the moment, to try and drive those [surgery] figures down.”

Hayes gave the state government an October deadline to get the inquiry under way, saying he expected it to rein in “billions” for redistribution within NSW Health.

But Bonning says the inquiry is a waste of money, and spending would be better injected into helping a depleted system now. “Based on previous inquiries we estimate that this special commission will cost between $50 million and $100 million in direct and indirect costs. The 2018 Special Commission of Inquiry into the drug ice cost $10 million and that was an inquiry into a single issue with just one commissioner.”

On the issue of locums, Bonning says: “The treasurer recently stated that [visiting medical officers] cost the system more than $1 billion a year. We don’t know where this figure came from, but it is wildly inaccurate. It appears he conflated the costs of locums and VMOs [visiting medical officers].”

“What people seem to think is that slashing the budget for VMOs would bring about some huge cost saving. It won’t. It’s not money that’s being taken out of the health system. We need doctors to do the work, and VMOs are the ones who step up and do it. Almost all surgery is performed by VMOs. Stop funding VMOs and you stop funding surgery.”

Bonning says locums are used to plug holes due to absences or unusually busy periods, and are more expensive due to their temporary and often last-minute employment. A better managed budget would rectify this spending, he says.

McGirr says the issue of locum doctors was felt the most in regional communities with a shortage of doctors, and any potential crackdown needed to be universal across the state and the country.

“Otherwise, you’ll just get people shifting around and going where they get paid,” he says. “But if we don’t [fix it], we will basically be in a situation where we lock in an overpaid, non-permanent workforce.”

Build enough hospitals to support a growing city

Despite telling the Herald that people and jobs, not infrastructure, were the priorities for him, Park says Labor will fulfil all election commitments to upgrade the state’s hospitals, and come good on new health infrastructure in the north-west.

Labor committed to adding 600 beds across Sydney’s west, half of those to go to the not-yet-built Rouse Hill Hospital, a hospital committed to by the previous government, but one that Labor will deliver.

“Communities are coming out of the ground there, and the infrastructure hasn’t kept pace,” Park says. Labor’s plans for Rouse Hill will cost $400 million more than the previous government predicted.

But Park would not commit to a completion date for any of the projects when asked by the Herald, his office later offering only that they would be delivered “within the term of government”.

There are no public hospitals in the Hills District, the nearest facility being the Norwest Hospital. It is operated privately by Healthscope, with which, at one point, one major health insurance provider refused to hold an agreement.

Tens of thousands of families, have moved to the area over the past decade, but they have a long way to trek to access a public emergency department. The closest is Blacktown – where people are waiting 30 hours to see a doctor – or Westmead, where patients are forced to sleep on the waiting room floor, such is the demand for help.

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