ACT does badly in AMA hospital report card.

johnboy 12 November 2008 78

The Shadow Minister for Health, Jeremy Hanson, is jumping all over today’s AMA report card on public hospitals:

    ““The ACT remains last in the country for attending to Emergency Department patients within the recommended time. The ACT Emergency Departments’ performance on this measure has plummeted under the Stanhope Government since 2002, from top of the league to the bottom.

    “Category Two elective surgery admissions are also the worst in Australia with our hospitals admitting less than half the number of patients within the recommended time. This is well below the AMA’s recommendation that 90% of elective surgery patients be seen within recommended times.

    “In addition, total elective surgery admissions rate equal last in Australia, so there is very little good news for the ACT when it comes to these fundamental health outcomes.” Mr Hanson said.”

[ED – Note to Zed, highlighting issues like this is what oppositions are supposed to do, you might want to try it sometime.]

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virgil99 virgil99 11:50 am 13 Nov 08

Agree completely about the wait for GP’s and specialists…..

Guidelines for waiting times were in fact created as an arbitrary, aspirational tool when the ATS (australasian triage scale) was developed by the ACEM. As said, no-one has proved an association.

When waiting times get long, there is a strong tendency for triage nurses to “up-triage” to make sure that patients get in (just a little bit) earlier. This makes numbers look worse, but in fact is no change to health care itself.

mdme workalot mdme workalot 11:45 am 13 Nov 08

Just reporting what I’ve been told virgil99. I guess we’ll see when the coroner’s report comes out whether the hospital was at fault. Although I must say that your faith in the health system is certainly admirable (even if I think it is a little naive) given some of the stories that have been reported on other hospitals over the last 12 months.

One comment – guidelines for waiting times are there for a reason. One would think they would be determined in accordance with sensible policy decisions and expert opinions. Therefore I would argue that waiting one minute beyond the prescribed waiting time IS relevant, as it shows either: a) the guidelines are unreasonable; or b) the hospital is not meeting it’s required performance indicators.

deejay deejay 11:39 am 13 Nov 08

We were astonished at how bad the health system was when we came here – and we are from the road-wreck that is NSW, so we know bad health systems. In all other respects we love Canberra and would never leave, but when urgent matters still result in a six month specialist wait, when GPs actually close their books to new patients and you have to wait a week for an appointment if they’ll see you at all…it’s hard to trust your health to it. I go to Goulburn for a GP (I can get in the same day) and for urgent matters, we go to Sydney for specialist care. Ludicrous.

virgil99 virgil99 11:29 am 13 Nov 08

Man, theres’s a lot of uninformed rubbish and heresay going into this discussion.
Lets put some of this in perspective.
1. This report means stuff all. Waiting times are dependent on a number of factors, but mostly on how many beds are available in the emergency department. There is no proven correlation between meeting those benchmarks and patient care. The figures do not differentiate at all between waiting for 1 minute too long, or 240 minutes too long. It must also be remembered that despite their protestations the AMA is not a health advocacy body, they are a union for doctors. They are playing for politics, not patient care (and I am a member of the AMA by the way)
2. There is no issue with funding or provision of senior medical staff in the ACT. There is an issue with a shortage of nurses. This is world-wide. This (rather than lack of funds or political will) then causes a shortage of available beds, which then causes overflows and delays in the emergency department.
3. Queanbeyan hospital is a tiny, effectively rural hospital run by a different health system so cannot be compared.
4. Canberra is not a big enough place to support all subspecialties. There is a “critical mass” of patients required to enable suitable infrastructure to be developed or employed. To give a list – paeds ICU, paeds oncology (the initial stage), paeds cardiology, adult spinal rehab, major burns plus many others are not immediately available. This reflects numbers, not laziness. The consequence of this is that some patients need to be transferred out to Sydney. This is always distressing for families, but is about creating a safe environment, not punishing anyone.
5. Despite perceptions above, no-one is turned away. There may be waits, but the implication above that a baby was allowed to die because no-one was available to see it is both damaging and impossible to believe. Without going into specifics of radonezh’s case, it would have worked like this. Seen by ED staff, referred to paeds staff for admission / treatment / observation. Paeds consultants unhappy to accept patient due to unfamiliarity with severe cardiac disease and (albeit small) chance of deterioration. Transfers are always done before the patient gets really sick , not waiting for that to happen. This will mean that some patients will get transferred that could have been managed in the ACT. It also means that patients don’t die because they’ve deteriorated in a hospital that doesn’t have facilities to provide ongoing high level care for them.
6. Canberra Hospital ED sees over 150 pts/day. Resources have to be spread and divided. By definition this means that many individual patients will have a less than “perfect” experience. Resources will always be directed to the most sick, and in particular to the most time-critical. To individuals in the other groups this may appear both inequitable and unfair.

There are clearly issues. Access block (which by the way more reflects efficient use of beds, rather than total bed numbers), nursing staff recruitment and retention, GP numbers (which has little / nothing to do with state government policy) and cost effectiveness of health money need to be considered. But the ACT issues reflect national trends, and there is no systemic ACT-specific issues here.

Thumper Thumper 11:24 am 13 Nov 08

A good point here is that the more it is discussed the more likely someone in power is likely to do something.

housebound housebound 10:36 am 13 Nov 08

bad typing in previous post – sorry.

justin heywood justin heywood 10:33 am 13 Nov 08

housebound said :

“We’ll find out when we see who the Greens support as the chair to the Assembly I think that Westminster model is a real dud for the ACT)”

I think you might be on to something there. The talent pool is too small.

.

housebound housebound 10:29 am 13 Nov 08

We’ll find out when we see who the Greens support as the chair to the Assembly Committee on Health.

If they support labor, the so-called agreement for ‘keep the bastards honest’ was really a power-sharing agreement.

if they support libs, thereby giving the Liberal chair access to ministerial briefs from the department, then I’ll believe the Greens really are about reform. (I presonally would ike to see this, but then I think that Westminster model is a real dud for the ACT)

Same argument applies to all Asssembly Committees not chaired by the Greens.

justin heywood justin heywood 10:11 am 13 Nov 08

housebound said :

The Greens are quiet. Maybe this isn’t part of their agenda – you know, the one they could pursue more with ALP than Libs.

Well I am hoping that the Greens will get their act together and play the ‘keep the bastards honest’ role that we need in that assembly.

Public health is not an area we should be playing politics with.

.

Granny Granny 10:10 am 13 Nov 08

Ganging up and giving people a hard time is easy. Any school kid would know how to do it!

Sic ’em, I say, and damn the torpedoes!!

housebound housebound 10:03 am 13 Nov 08

The responsible Minister isn’t actually responsible.

The Greens are quiet. Maybe this isn’t part of their agenda – you know, the one they could pursue more with ALP than Libs.

The Libs are not in touch with the portfolio. I hope that’s just because Hanson is new to the job. There wouldn’t be much they could do anyway, what with not having any power an’ all.

radonezh radonezh 9:58 am 13 Nov 08

housebound: leaving town is certainly on the cards. Gotta wait for BabyRad #3 to be born first! To be honest, we we moved here, I had no idea the system was so weak. On the surface everything looked fine. Yes, Melbourne is very good in the paed cardio area, and so are the hospitals in Sydney and Brisbane. In the mean time, we’re here for at least another 12 months I’d say. What hurts is that the kids love their school here and have really formed some good friendships. Again, it’s the nation’s capital – families living here shouldn’t have to make decisions like this because the services here should be at least as good as as any other capital city in Australia regardless of the size of population. Canberra should be setting the standard, not bringing up the rear.

justin heywood justin heywood 9:54 am 13 Nov 08

I was taken to Canbera Hospital Emergency after a serious (fatal) car accident. I spent time in the emergency department and in the wards. I survived, but after what I observed I have told my wife; Next time, if I’m still breathing, take me to Sydney.

I’m not surprised that TCH is the worst in the country. Morale appears bad amongst the staff, and this hospital underperforms despite the money thrown at it.

For those in charge to say “it’s OK, we’re better than we were” is not acceptable. SOMEONE needs to but a broom through senior management.

If the responsible minister won’t even admit that things are bad, what hope is there?

.

housebound housebound 9:36 am 13 Nov 08

I am not surprised at either Radonezh or mdme workalot’s stories.

Our experience (9 years in and out of hospital until the final operation) was fine, but we had something they knew about and a very aggressive surgeon who was prepared to fight the system for us. Without that, we could still have been waiting for the first operation thanks to the bean counters deciding it wasn’t critical enough. I suspect things have got worse in the last decade.

In Radonezh’s case, I would leave town. Your child is worth too much to waste her life here.

I hear that Melbourne is good. It has public transport AND hospitals. (Quite seriously, we have friends who did move there once their child was diagnosed with something that the Canberra system couldn’t manage.)

I really feel for parents, or anyone, trying to navigate this hospital system.

Granny Granny 9:34 am 13 Nov 08

Well, I think the Greens and Liberals should give them absolute hell in the assembly until enough personnel and procedures have changed and enough resources allocated that the community can be confident this sort of situation will simply not recur in this hospital.

Show them why we voted for you!!

And I actually believe that this kind of negligence is just criminal.

It sounds like the whole organisational culture may need to change ….

mdme workalot mdme workalot 9:19 am 13 Nov 08

I sincerely hope so Granny.

There will be a coroners inquest (hopefully before the end of the year) but really, what is that going to do? Provide some recommendations, slap the hospital on the wrist and watch the situation repeat itself in another couple of years?

Sorry I sound pessimistic, but I think it’s just disgraceful. In my opinion, I think it would be worthwhile for the parents to sue. Unfortunately this world revolves around money, and if the hospital loses enough it might motivate them to do something about it.

Granny Granny 9:07 am 13 Nov 08

If this is true, heads should roll.

mdme workalot mdme workalot 9:02 am 13 Nov 08

Just wanted to impart a pretty horrific story I heard from a friend I haven’t seen for a while yesterday.

Last year my friend’s wife gave birth to a little boy. This little boy was born with numerous health problems including cerebral palsy and several internal issues. The child was born in Canberra and quickly ferried up to Westmead in the chopper. No problems.

Due to some of the problems he was born with, this little boy was required to have surgery on his internal organs at 6 months of age. The operation was done, the boy was sent home. No problems.

One week later, the little boy is sick. His stomach is distended and an odd colour, he’s having difficulty breathing and he is vomiting. The child’s mother took him to the Canberra Hospital around lunchtime, where he was seen by a doctor. The doctor advised that there was some slight internal bleeding, but the child would be fine. The child and his mother were sent home.

The child’s father arrived home around 6 pm and was horrified at the state his son was in. The physical signs were becoming worse, and the child was gurgling and going in and out of consciousness. The family headed to the Canberra Hospital once more.

The child was examined by the same nurse who had seen the child earlier that day. Again, the parents were told the child was fine and to take him home. This time, the parents refused. They were told there was no bed available for him, there was no doctor available until the following morning and they weren’t prepared to arrange for the child to be transported elsewhere. The parents felt they had no choice – they decided to wait at the Hospital until a doctor was available the next morning.

Unfortunately, this little boy died during the night, before being seen by a doctor.

Now this story comes with the disclaimer that it was told to me by a parent who would (quite understandably) be quite upset with the hospital, so please do take it with a grain of salt. Certain misunderstandings may have been made and other points exaggerated. It happens. However, how the f**k does something like this happen in a country like Australia? How can an obviously seriously ill child be left to die in a waiting room after being turned away from a hospital?

radonezh radonezh 12:03 am 13 Nov 08

poptop said :

By the way radonez – it isn’t unreasonable to expect our children to receive proper health care. I’m sorry to hear about your daughter’s health issues and hope everything works out.

She sounds a delight.

Thanks poptop. She is a delight, but her situation isn’t. Whatever happens, it’s God’s will (and so is the fact that there are medical specialists who can help her out there.) Wish they were a bit closer to Canberra though!

radonezh radonezh 11:57 pm 12 Nov 08

poptop said :

I thought the Canberra hospital was the Regional Hospital – thereby explaining the needs for the SouthCare Helicopter in convenient proximity to the Alexander McConochie Human Rights Centre.

The internets is telling me that QBN is a Level 3, 45 Bed Hospital, while the Canberra Hospital is an acute care teaching hospital of approximately 500 beds, and a tertiary referral centre that provides a broad range of specialist services to the people of the ACT and South East NSW.

They sound like different beasts, although there probably are some benefits in amalgamating them.

Which one will we implode?

I dunno. All I know is that I hate state borders.

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