Today our emergency department was once again overflowing. Sick patients waiting to access our care lay on beds spilling into the corridors, whilst many more inside occupy our beds waiting for a space to become available in the hospital wards.
This deadly gridlock has become the new normal. And the normal is bad.
Very bad.

Here are some clipped excerpts from a very interesting paper published by the Jeremy Sammut from the Centre for Independent Studies titled: Why Public Hospitals Are Overcrowded.
If you are currently working in the Australian health system you might have some comments to make on Mr Sammuts assessment of the lay of the hospital land.
You can download the entire paper as a pdf file.

Why Public Hospitals Are Overcrowded.

“Twenty-five years of nationwide cuts to the number of acute public hospital beds in Australia means our public hospitals are dangerously overcrowded. In the context of rising demand for admission from an ageing population, the vast majority of urban public hospitals are unable to operate at a safe level of 85% bed occupancy.
The Australian Medical Association’s 2008 Public Hospital Report Card received national media coverage when released last November. The report card detailed new academic research linking overcrowding with 1,500 avoidable deaths per year-more than the national road toll. Not even national headlines that screamed ‘1,500 die waiting for bed’ generated an appropriate policy response.
Australian and overseas studies overwhelmingly show that the single-most important cause of public hospital overcrowding, from a technical perspective, is the national shortage of acute hospital beds. In the age of spin and media management, however, only a ‘brave’ health minister would admit that public hospitals don’t have enough beds to provide a safe standard of emergency care for acutely ill patients who require unplanned admission to a hospital and cannot be treated elsewhere in the health system. Rather than admit the truth about the scale of the crisis in our ‘free and universal’ hospital system, governments prefer to blame extraneous factors such as GP shortages.

Overcrowding [of our emergency departments] causes unnecessary suffering and is associated with longer stays and poorer clinical outcomes for admitted patients, including higher morbidity and mortality rates. Because the cancellation of elective surgery is the standard crisis response, bed shortages also contribute to blow outs in elective waiting times.
Overcrowding also imposes a heavy toll on the overworked, stressed, and burnt out emergency staff upon whose professionalism and dedication the health and welfare of every Australian could one day depend.

The key statistic is the number of acute hospital beds per 1,000 population…. Public hospital beds have been cut by one-third in the last 25 years….Between 1995 and 2006 alone, total bed numbers fell by 3.2% and by 11% per 1,000 population. The fall was entirely due to an 18% reduction in public beds.
The reduction in bed numbers is bigger than it seems taking population growth into account-a 60% fall from 4.8 public acute beds per 1,000 in 1983 to around 2.5 per 1,000 today.

[The current] government is pursuing a primary care centred reform agenda that has failed to fix the hospital crisis in countries such as New Zealand. This agenda entails spending billions of dollars on a national network of GP Super Clinics offering all-hours general practice services for GP-style patients and enhanced primary care services for elderly chronic disease patients. Unfortunately, it will not take the pressure off public hospitals as promised but will waste money by duplicating existing state and federally funded programs that are already caring for the elderly.
…the evidence that primary care can substitute for beds is anecdotal and weak at best. Rather than evidence-based policy, this is the preferred policy agenda of community health and other select public sector provider groups that want greater funding poured into their health silos.
[The current] government’s wrong-headed approach is predicated on the idea the hospital crisis has been precipitated by too much focus on hospitals and not enough on prevention. In reality, the problems in public hospitals are partly attributable to the success of better prevention, which is enabling increasing numbers of people to live to older ages and deferring illness to later stages of life. Effective deferment of illness means that ‘very old’ patients will inevitably get acutely ill and require admission
to hospitals. This age group will be the hospital patients of the twenty-first century.

Public hospitals have been mismanaged on an epic scale. Taxpayer dollars have been channeled into useless bureaucracy at the expense of patient care. Hospitals provide essential services that the community is going to need more and more in coming decades. So essential are these services that government bureaucracies cannot continue to be allowed to run and ruin hospitals.”