Monday, September 27, 2010

Crisis in WA hospitals

This op ed piece by Professor Gavin Mooney appeared in the West Australian on Friday September 24th in response to ongoing problems in the WA health care system, highlighted by a recent crises involving ambulance ramping at the city's major public hospitals.
Ambulance ramping
The accounts of the ramping of ambulances at the major Perth hospitals last week are worrying and one feels very much for the patients involved and their families. Something clearly is going wrong and, while last week was particularly bad, these events do occur with some regularity.
 But let’s stop and think this through a bit more. There will never be a health care system in WA or anywhere else that can meet all demands and needs for health care. No society can ever achieve that. If we tried to, it would be so expensive and we would end up with very poor educational, transport and justice systems. Or we would have to cut back markedly on private consumption as we paid more and more in taxes. Or, if we went further down the private road, we’d be spending enormous amounts on private health insurance.
Taking public and private together, as a country or as a state, do we spend enough on health care? Well in comparison with other countries we seem to be getting it about right – although out of the total we do spend rather a high proportion on hospitals.
But then of course we need hospitals!  My questions however are these.
First have we got the right mix of types of hospitals? And second have we got the right mix of types of health services? The Reid Review of 2004 which is the most recent assessment of the WA health service indicated that 80% of patients in our big teaching hospitals did not need to be there. That is a staggering figure, especially as these are very expensive places to be. 
There is a ‘law’ in health policy that says ‘a built bed is a filled bed’ meaning that if we create more beds they automatically get used. That 80% figure clearly suggests an oversupply of beds in our big hospitals. Many patients could be treated just as well but at less cost in other hospitals. Rather than building the Fiona Stanley Hospital what we should be doing is expanding other, cheaper hospitals. 
But maybe we need to increase services outside of hospitals – GP and community services, preventive services. It is of note that in the “Citizens’ Juries” (of randomly selected citizens brought together and given good information) in this state that I have facilitated, when asked about their priorities, not one has wanted more hospital beds. Indeed to pay for the priorities that they as citizens want – prevention, mental illness, greater equity, community care - some juries have suggested closing hospital beds!
The push for more and more beds is simply not working. I have been in the west for 10 years and over that period we have pumped more and more money into these teaching hospitals and we still have the ramping of last week. These hospitals are ‘sick’ but the ‘treatment’ over the last decade is not working. We need more ‘investigations’ so that we can up with a better ‘diagnosis’. 
What to do? Well the first thing - and I have asked for this repeatedly – is to conduct a detailed investigation into our teaching hospitals. Where is the money going? What is driving costs? Can the services be provided as well but at less cost i.e. more efficiently? That sort of detailed study was not done by Reid and it has not been done since. We cannot make sense of any of this until that study is done.
The second thing is to put in place more policies to keep people in the community – bolster prevention and invest in programs to keep people out of hospital. Most people want to live as long as they can in their own homes. Let’s respect that. And it is cheaper. 
And third let’s find out what the people of WA want from our health services – and they are our health services, not the doctors’, not the politicians’, not the Health Department’s. They are ours, the citizens’. Let’s have a series of these “Citizens’ Juries”, say ten across the state, so that critically informed citizens can have a genuine say in the future of the WA health service.
Early last month I did one of these Citizens’ Juries in the ACT at the request of the Minister of Health in the ACT, with fascinating results for their services.
Dr Hames, Mr Snowball, I make this plea. In response to ambulance ramping, instead of pouring more and more money into these expensive hospitals, let’s have an investigation into how the vast sums of money they are currently getting current are being used. And rather than assume that supplying more and more beds is the answer, let’s work on reducing demand.  And finally will you please fund a program of Citizens’ Juries across the state so that you can learn what we as citizens want from our WA health services?
Professor Gavin Mooney, Health Economist and Co-convenor, WA Social Justice Network 

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