The sickening state of healthcare

The hospital squeeze means the huge pool of untreated patients grows each year, writes Martin Goddard

THE figures are scary. Tasmania’s hospital system has been in steep decline for at least a decade, but what is ahead will be far worse than what we already endure.

The hospitals are now completely full. There is almost no space for any more patients than they currently treat.

The snag is that hospital demand rises, inexorably, by about 4 per cent a year. That’s well over 5000 people needing care, or about 1 per cent of the entire population. If their cases are serious enough, those new patients will be treated. But it will be at the expense of others, who have already been waiting for many months and, often, for years.

So the already immense pool of untreated people is now rising every year by 1 per cent of the population and will go on doing so until more space is built.

Even that understates the seriousness of the situation. Rates of chronic conditions – such as diabetes, dementia, cardiovascular disease, obesity, kidney disease, mental illness – have been rising. So the amount of medical and surgical care needed by the community is higher than the raw figures indicate.

Then there are the complications suffered by people whose conditions have been neglected for too long.

Those problems not only multiply costs when they finally are treated, but cause massive and avoidable personal suffering – and, sometimes, death.

Let’s take the case of someone with osteoarthritis needing a hip replacement.

Walking hurts, so they don’t. Because of that lack of activity, they put on weight. That adds stress on the joints, so the arthritis becomes worse and a vicious cycle ensues.

Now overweight or obese, they develop high blood pressure and cholesterol builds up in their arteries, massively increasing the risk of heart attack and stroke.

Then diabetes develops, with its own vast range of further complications – kidney disease, heart damage, foot ulcers, lung disease and a significant chance of an early death.

All of this would have been avoided if the operation had taken place when it was first needed.

If they exist, publicly funded community health facilities can treat people with those conditions more cheaply and suitably away from hospital. Nowhere in Australia are there enough of these services, but every other state is better off than Tasmania.

Because our population needs more of this care than other states, but has fewer private-sector alternatives, the Commonwealth Grants Commission calculates the state government needs to spend 35 per cent more on community health than the rest of the country. And they give us extra GST revenue so we can pay for it.

But the government has other priorities for most of that money. In 2018-19, it spent $278m less than the amount needed to provide a level of service that people in other states take for granted.

Adequate community health resources could reduce the annual rise in hospital admissions from 4 per cent to 3.5 per cent, maybe more. That would be a big win for everyone.

Because our hospitals are so overcrowded and chaotic, staff cannot work efficiently – so costs have soared. In 201516, the cost of treating an average inpatient in a Tasmanian public hospital was 1.7 per cent below the national average. Two years later, it was 6.7 per cent above.

If enough ward space was provided so our doctors and nurses could work as efficiently as those in other states, they could treat about 20 per cent more patients than they now do. That translates into almost 25,000 hospital admissions every year.

The crisis would be over. But in almost seven years in office, the present government has not commissioned a single significant hospital building project. The new K-block at the Royal Hobart Hospital was begun by the previous government a decade ago.

Now we are living with the consequences of that neglect.

Wards in the old RHH

buildings, vacated in the move to K-block, need extensive refurbishment and reconfiguration, but the process is glacially slow. Work is needed urgently to put into effect the existing plans for a second campus on the former Repatriation Hospital site. Maybe by 2050, says the government. At the Launceston General Hospital, where critical overcrowding is even worse, a masterplan process has now stalled. The Health Minister, Sarah Courtney, could step in to get it going again, but she has not. If new projects were approved today, it would take at least five years before patients could benefit. The only short-term solution is in temporary buildings, prefabricated offsite and quickly assembled. A year ago in Wuhan, Chinese authorities built such a hospital – with 1000 beds – in a fortnight. It might take us a little longer.