Jeremy Hanson seems to have mistaken correlation for causation. His example that following the Auditor-General’s audit of elective surgery waiting lists in 2010 things have improved has ignored a major change in the elective surgery landscape.

In 2011 all states and territories agreed to the National Elective Surgery Target (NEST) in return for Commonwealth funding. The NEST aims to have each jurisdiction perform 100% of elective surgery within the clinician-assigned timeframe by 2016, with a number of interim targets along the way. There are complementary national and jurisdictional strategies that are being implemented to help states and territories achieve these targets.

While I don’t doubt the Auditor-General’s report has helped contribute to the improvement in ACT elective surgery waiting times, I remain doubtful that the report is the underlying cause.

As for an audit of ED treatment times, it would almost certainly be useful, but unlikely to be the panacea that Hanson is selling it as.

peitab said :

Jeremy Hanson seems to have mistaken correlation for causation. His example that following the Auditor-General’s audit of elective surgery waiting lists in 2010 things have improved has ignored a major change in the elective surgery landscape.

In 2011 all states and territories agreed to the National Elective Surgery Target (NEST) in return for Commonwealth funding. The NEST aims to have each jurisdiction perform 100% of elective surgery within the clinician-assigned timeframe by 2016, with a number of interim targets along the way. There are complementary national and jurisdictional strategies that are being implemented to help states and territories achieve these targets.

While I don’t doubt the Auditor-General’s report has helped contribute to the improvement in ACT elective surgery waiting times, I remain doubtful that the report is the underlying cause.

As for an audit of ED treatment times, it would almost certainly be useful, but unlikely to be the panacea that Hanson is selling it as.

As usual, he’s playing to the peanut gallery – the ignorant and the tinfoil hat brigade who believe that it’s all a political conspiracy or incompetence which can be fixed by electing the “right” party.

None of the political noise addresses the triple reality:

* People who use the Emergency Department for non-emergencies (related to the lack of GPs and GP availability in Canberra);

* Inadequate ED resources (not just a matter of money, also a matter of the number of available doctors an nurses); and

* The number of NSW residents using ACT hospitals without appropriate compensation from the NSW government.

When you hear them talking about and suggesting strategies to address those things you’ll know they’re finally being honest about it. Don’t hold your breath.

don’t forget 90% of health spending going on the last six months of life.

johnboy said :

don’t forget 90% of health spending going on the last six months of life.

Sounds like you are advocating euthanasia.

Deref said :

* Inadequate ED resources (not just a matter of money, also a matter of the number of available doctors an nurses); and

This is largely a matter of money – because Nurses have to have done a grad year to be qualified, there’s a bottleneck between people graduating with nursing degrees and fully qualified nurses. This IS a matter of money (and of time) – there’s actually an excess of graduates in nursing and to an extent medicine who’ve been left in nowhereland because State/Territory health systems haven’t ponied up the money for enough grad places.
(https://ama.com.au/media/junior-doctors-and-medical-students-call-urgent-solution-medical-training-crisis) – on the issue in medicine.
This has been going on for a while and is getting worse, so problems with staff shortages can be at the very least tied to yesterdays poor decisions – and given Canberra hospitals have been bad and getting worse for the better part of a decade now, it’s pretty damn reasonable to blame the government as they’ve had ample time to fix it. Had more money been spent on grad nurses and doctors from say, 2008 to now, and less on phallic owls, we would undeniably have a better health system.

+1 to Deref’s three * points, and to JB’s subsequent point.

In Health, and other major areas of public policy, Canberra needs and deserves a far more mature, sophisticated, honest and realistic policy debate.

johnboy said :

don’t forget 90% of health spending going on the last six months of life.

And yet we still won’t allow people to end their lives quickly and cleanly. If we didn’t have these pointless anti-euthanasia laws I bet you would see a substantial drop in the amount of money being lost needlessly prolonging the suffering of the terminally ill.

DrKoresh said :

johnboy said :

don’t forget 90% of health spending going on the last six months of life.

And yet we still won’t allow people to end their lives quickly and cleanly. If we didn’t have these pointless anti-euthanasia laws I bet you would see a substantial drop in the amount of money being lost needlessly prolonging the suffering of the terminally ill.

That’s what I was alluding to but I didn’t expect that you would agree with me.

Ian said :

The lack of access to the emergency department is having a huge impact on many Canberrans health.

I wonder if it has a huge impact on anyone’s health actually, or is just a waste of people’s time hanging around waiting.

Deref said :

peitab said :

* The number of NSW residents using ACT hospitals without appropriate compensation from the NSW government.

Just on this point, a couple of issues:
1) NSW does pay ACT for the pleasure – try googling it.
2) I am a NSW resident, and TCH is my third choice of hospital. I will try Cooma first and then Qbn, and only go to TCH if I can’t get in to either of those two (noting that I’ve never been turned away from one of the NSW before). I don’t know why people bother going to TCH – it’s awful.

vet111 said :

Deref said :

peitab said :

* The number of NSW residents using ACT hospitals without appropriate compensation from the NSW government.

Just on this point, a couple of issues:
1) NSW does pay ACT for the pleasure – try googling it.

Yes, it does, which is why I said “inappropriate” – not “no” – compensation. The shortfall’s enormous.

vet111 said :

2) I am a NSW resident, and TCH is my third choice of hospital. I will try Cooma first and then Qbn, and only go to TCH if I can’t get in to either of those two (noting that I’ve never been turned away from one of the NSW before). I don’t know why people bother going to TCH – it’s awful.

Yes, it is. And good for you. Unfortunately many, many NSW residents choose to use Canberra’s hospitals and schools rather than their own. I don’t have a problem with that providing ACT ratepayers are fully compensated, which we’re not.

DrKoresh said :

johnboy said :

don’t forget 90% of health spending going on the last six months of life.

And yet we still won’t allow people to end their lives quickly and cleanly. If we didn’t have these pointless anti-euthanasia laws I bet you would see a substantial drop in the amount of money being lost needlessly prolonging the suffering of the terminally ill.

Hear, hear. If you treated your dog the way we treat those who want to end their lives with dignity and at the time of their own choosing we’d be rightly prosecuted. Thanks, religion.

Deref – TCH is the only tertiary hospital in the region. People get send there after presenting at Qbn and Cooma hospitals. Hell, people get sent there from Calvary.
Calvary can’t/won’t even deal with compound fractures while Qbn, Yass and Cooma have even less capability.
- anything remotely serious is going to be sent to Canberra hospital no matter where it is that the patients initially present. Where else would you suggest people from nearby areas of NSW go? 300km up the road to Sydney?

Tetranitrate said :

Deref – TCH is the only tertiary hospital in the region. People get send there after presenting at Qbn and Cooma hospitals. Hell, people get sent there from Calvary.
Calvary can’t/won’t even deal with compound fractures while Qbn, Yass and Cooma have even less capability.
- anything remotely serious is going to be sent to Canberra hospital no matter where it is that the patients initially present. Where else would you suggest people from nearby areas of NSW go? 300km up the road to Sydney?

As I’ve said twice now, what I want is for Canberra to be adequately reimbursed by NSW.

Deref said :

peitab said :

Jeremy Hanson seems to have mistaken correlation for causation. His example that following the Auditor-General’s audit of elective surgery waiting lists in 2010 things have improved has ignored a major change in the elective surgery landscape.

In 2011 all states and territories agreed to the National Elective Surgery Target (NEST) in return for Commonwealth funding. The NEST aims to have each jurisdiction perform 100% of elective surgery within the clinician-assigned timeframe by 2016, with a number of interim targets along the way. There are complementary national and jurisdictional strategies that are being implemented to help states and territories achieve these targets.

While I don’t doubt the Auditor-General’s report has helped contribute to the improvement in ACT elective surgery waiting times, I remain doubtful that the report is the underlying cause.

As for an audit of ED treatment times, it would almost certainly be useful, but unlikely to be the panacea that Hanson is selling it as.

As usual, he’s playing to the peanut gallery – the ignorant and the tinfoil hat brigade who believe that it’s all a political conspiracy or incompetence which can be fixed by electing the “right” party.

None of the political noise addresses the triple reality:

* People who use the Emergency Department for non-emergencies (related to the lack of GPs and GP availability in Canberra);

* Inadequate ED resources (not just a matter of money, also a matter of the number of available doctors an nurses); and

* The number of NSW residents using ACT hospitals without appropriate compensation from the NSW government.

When you hear them talking about and suggesting strategies to address those things you’ll know they’re finally being honest about it. Don’t hold your breath.

So, it’s all the fault of the patients not being sick enough, or those dastardly (and now Liberal) New South Welshman, or the lack of doctors and nurses?

While I’m certainly willing to accept that the dire problems at TCH have complex causes, I don’t accept that the government should not shoulder any blame. And it is certainly the job of any competent opposition to point out the problems – it’s not just the ‘peanut gallery’ who would like some effective action taken to fix it.

Katy was certainly willing to accept the credit when the (ahem) figures were showing that things were going well.

Deref said :

peitab said :

None of the political noise addresses the triple reality:

* People who use the Emergency Department for non-emergencies (related to the lack of GPs and GP availability in Canberra);

* Inadequate ED resources (not just a matter of money, also a matter of the number of available doctors an nurses); and

* The number of NSW residents using ACT hospitals without appropriate compensation from the NSW government.

When you hear them talking about and suggesting strategies to address those things you’ll know they’re finally being honest about it. Don’t hold your breath.

1. People presenting to TCH ED for non-emergencies constitute quite a small minority of total presentations. And apart from tying up the triage and clerical staff out the front briefly, such patients have very little impact on waiting times for those with genuine emergencies. Attributing a significant part of prolonged ED waiting times to patients presenting with non-emergencies has become a convenient political football in recent years, because it allows politicians to trot out band-aid “solutions” like GP superclinics and announce to the world that they are doing something concrete to address long ED waiting times. Anyone with any knowledge of the workings of a tertiary hospital, and of a tertiary ED in particular, knows this is a red herring doled out to appease an ignorant public.

2. ED can always use more resources, in terms of bed spaces, equipment and staff. Bring it on. Please. However, much as in point # 1 above, lack of intrinsic ED resources is not in itself a major cause of prolonged waiting times. If TCH ED had 100 beds (instead of the 42 it has) we would whip the first 100 people into them nice and fast… and then come to a grinding halt again in short order, and our waiting times would return to close to what they were before The Great Bed Expansion Event.

3. Yes we see a truckload of NSW patients, and the NSW govt pays the ACT for it. Whether they pay us _enough_ is a point of contention. The effect of NSW underpaying the ACT (which they do) has an indirect effect on ED waiting times in that the hospital _as a whole_ is under-resourced for the ACT+NSW population it is expected to serve. The lack of hospital beds for said population then causes access block, which causes prolonged ED waiting times, and excess morbidity and mortality (worse health outcomes and death) in those ED patients affected.

People wait too long to be seen in ED because the ED is full. The ED is full because the hospital is full (and we have nowhere to send our admitted patients). The hospital is full because it is too small (i.e. too few acute beds) for the population it is expected to service.

We don’t need an inquiry. We need more inpatient beds and, as a result, a more efficient ED. Spending time and resources seeking answers we _already have_ is pointless and daft.

Deref said :

Tetranitrate said :

Deref – TCH is the only tertiary hospital in the region. People get send there after presenting at Qbn and Cooma hospitals. Hell, people get sent there from Calvary.
Calvary can’t/won’t even deal with compound fractures while Qbn, Yass and Cooma have even less capability.
- anything remotely serious is going to be sent to Canberra hospital no matter where it is that the patients initially present. Where else would you suggest people from nearby areas of NSW go? 300km up the road to Sydney?

As I’ve said twice now, what I want is for Canberra to be adequately reimbursed by NSW.

I am inclined, once again, simply to say +1 to what Deref said, but it would be interesting to hear from someone who really does know enough about the details of this as to whether the current funding provided to the ACT for treating NSW residents is truly fair and reasonable after being adjusted, of course, for the cost of treating ACT residents in NSW hospitals – in cases where the treatment is only available in a major Sydney hospital or because, for some other reason, ACT residents choose to, or have no choice but to, be treated in a NSW hospital. I assume there are cross-border issues for other jurisdictions, but given that we are so small, compared to NSW, the money involved for the ACT may well be more than “loose change” (as it may be in the case of NSW/Qld or NSW/Vic).