After a litany of shifting excuses WA Labor finally admits to its sore spot

It’s Health Week in the lead up to Treasurer Mark McGowan’s second state budget due next Thursday, with a $252 million ambulance ramping reform plan announced on Monday and a $223 million infrastructure plan announced on Tuesday.

It’s recognition that after two years of pandemic politics the health system – always a potential achilles heel for any state government – has become a significant trouble spot for WA Labor.

It is the reset/clean up job that comes after shifting deputy premier Roger Cook out of the health portfolio at the end of last year, and after McGowan has declared mission accomplished on the soft landing for COVID.

The death of 7-year-old Aishwarya Aswath at the brand new and supposedly world class Perth Children’s Hospital, amid what can only be characterised as system-level neglect, shocked and outraged the public.

Ambulance ramping, where patients sit and wait in the back of ambulances or in hospital corridors due to a lack of capacity to admit them through public hospital emergency departments, is now a mainstream worry 18 months after the medical director of St John’s ambulance Paul Bailey first raised concerns about a system crunch.

The initial political response by Cook when that concern was raised in August 2020 was to claim it wasn’t true and the figures were wrong, but since then it is indisputable that ambulance ramping has exploded, causing harm to patients and strain to ambulance availability.

Ramping was running at about 1000 hours a month when Cook, from Opposition, declared ramping under the Barnett Government a crisis; it was 2700 hours when Bailey raised the issue publicly; it has since surged past 6000 hours some months and was over 5100 hours in April.

After a litany of shifting excuses, it is now acknowledged by the government that ramping is a systemic problem – hence the $252 million package which funds 17 different measures.

Health Minister Amber Jade Sanderson acknowledges it will take months – at least – for the problem to begin to turn around but the package won the support on Tuesday of the Australian College of Emergency Medicine.

Australia’s mixed public/private, Commonwealth/State funded hospital system has strengths, but weaknesses too, including overlapping accountabilities and responsibilities and a misalignment of interests.

For instance, GPs (funded by the Commonwealth) provide primary care but can be difficult to access out of hours. Or, they charge gap fees, making a free state run hospital emergency department a more attractive (or immediately practical) option for patients.

McGowan has made the point this week that WA has the lowest per capita number of general practitioners in the country, which is putting more pressure on the state funded EDs as people seek care.

This has been true for decades, which is why it was such a big deal that the Abbott Government approved a new medical school for Curtin University at Midland in Perth’s underserved eastern suburbs, after lobbying from Barnett and over the bitter objections of the AMA WA.

The reform package’s single biggest commitment is $60 million for 120 aged care beds (aged care being another Commonwealth responsibility) to transition older patients out of hospital.

There is also money for telehealth initiatives and investments at the system level which are aimed at better matching modes of care to the needs and acuity of patients.

These sound encouraging, but then so did Cook’s Sustainable Health Review exercise begun after the McGowan Government was elected in 2017, another big picture reform effort that yielded limited successes.

The point is that 18 months have been wasted with political denials of reality, in which time the problems have become much worse.

Fundamentally the task is to keep people out of hospital in the first place and wherever possible to divert them to lower-cost care outside of emergency department and tertiary hospital settings. This need has been recognised for at least 15 years but we just don’t seem to be able to manage it.

Emergency doctor and ACEM’s WA faculty chair Professor Peter Allely told me on 6PR Breakfast on Tuesday that he and colleagues were continuing to see patients whose medical needs are increasingly complex, which he put down in part the consequences of delayed or deferred care over the COVID period.

With the big elective surgery machine still very much cranking back up after its own COVID disruptions, it would be unsurprising if this trend increased in the next year or two.

Allely argues emergency departments have more capacity to treat patients who come in through the front door, but it is exiting them through the back door that is creating the bottleneck.

The AMA’s mantra is always more beds.

Fiona Stanley Hospital was the last new tertiary hospital to open in WA, in 2014-15, its 783 new beds offset by the downgrading of some services at Fremantle and Royal Perth hospitals.

Perth Children’s Hospital, which finally opened after extensive water system problems in 2018, replaced Princess Margaret Hospital and added about 70 additional beds.

McGowan has announced a $1. 8 billion allocation to replace ageing King Edward Memorial maternity hospital but its completion is at least half a decade off or more.

In the meantime, the focus has been on adding beds incrementally, with 530 new beds pledged to various sites across the state’s hospital portfolio to come on stream over the next couple of years.

As ever, the big challenge is workforce, where WA has become accustomed to importing its needs from overseas.

After the pandemic, every jurisdiction in the world is short on healthcare workers (as in seemingly every other industry) so a quick fix is unlikely.

Cut through the noise of the federal election campaign with news, views and expert analysis from Jacqueline Maley.

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