dr. Clare Skinner: Every part of the health system needs to be reformed to put patients first

We are in the most challenging times our health professionals have ever experienced and only deep structural reforms can solve the crisis.

Emergency care has been in the news a lot lately. We’ve seen front-page photos of ambulances queuing outside hospitals, and almost every day coverage from across the state and nation about the enormous strain and cracks in health care systems.

This is the public face of the health crisis plaguing the country. But these are more than just pictures, TV news jokes, or words on a page.

This is about people. Real people in need of urgent, life-saving medical care. Sick, injured, frightened and vulnerable people, who cannot be transferred from ambulances to emergency rooms and then to hospital wards for the further care they need.

These are stories of people waiting for hours in crowded waiting rooms or being treated in hallways – in some tragic cases, they suffer avoidable damage, as EDs are dangerously overloaded and unsafe.

This is heartbreaking for frontline health professionals, including the highly trained and experienced doctors and nurses who work in the emergency room. Many senior practitioners with decades of experience tell me that these are the busiest and most challenging times of their careers. They feel that things are at a breaking point.

When you see ambulances lining the street, or crowded waiting rooms, it’s tempting to think it’s the ER’s fault. You might think that if the ED staff just worked harder, the queue would disappear. But I can tell you, hand to heart, we work as hard as we can.

In the meantime, we must apologize for problems we have not caused – people beg to please be patient with us in the most difficult of circumstances.

We do our very best in a system that doesn’t work for us or for the people we so desperately want to help.

The fundamental problem is the way our health system is structured. Within the health system, EDs are at the crossroads between the acute hospital sector and community care.

In Australia, acute hospital care – including emergency care – is funded and administered by state and territory governments. Community-based care, including specialty general practices, residential aged care, pharmaceutical benefits and disability care, is overseen by the Commonwealth.

It is an artificial divide, as most people, especially those with chronic illness or complex health care needs, will interact with all parts of the system.

This artificial divide leads to cost diversion and blame shifting by governments. This leads to administrative delays and a lack of service integration. Meanwhile, patients and their loved ones try to navigate a nearly impossible system.

Divided public and private health sectors in Australia make it even more difficult. This has led to rising costs for patients and makes measuring health care system performance and patient outcomes even more difficult.

No wonder we see growing health and social inequalities.

If you’ve had an urgent medical problem, or helped care for a sick family member, you know that accessing the right healthcare at the right time is often confusing, difficult and sometimes very expensive. Emergency Departments are the only parts of the system that are open 24 hours a day and are free at the point-of-care.

When the rest of the health system is overloaded, costs too much, or is too difficult to navigate quickly, the demand for emergency care increases.

But if the whole system becomes overloaded, as is now the case in much of the country, all hospital beds are already full.

Many patients in these ward beds are being treated for acute conditions, but many are also awaiting placement in aged care facilities, or approval for disability support funding, or places in an appropriate mental health outreach program. They are only in the hospital because they have nowhere else to go.

Full hospitals means that people who have been assessed by ED doctors and who need to be hospitalized have to wait for the ER. Therefore, there are no beds available for the treatment of new patients arriving at the ED.

It will only be standing room in the ED waiting room, but the problem is not caused by EDs. A lack of capacity and poor flow throughout the health system are causing this crisis.

Solutions to this healthcare emergency are not easy and do not lie in the emergency department. Deep, structural health system reform is needed to bring our self-contained health services together into a coordinated, effective, patient-centred system.

Possible strategies include a single payer for all health services and better use of monitoring and data to improve patient experience and outcomes. Patients, caregivers and frontline clinicians should be involved in the redesign of the system.

In addition, we must ensure that every part of our health system, including emergency rooms, has sufficient staff and capacity to ensure that the system as a whole can function effectively.

The Australian health system last underwent a major upgrade in the 1980s, when Medicare was introduced. Australians are now living longer and, thanks to advances in clinical science, have significantly different health needs. It’s time to rethink – to design a health system that is fair, safe and effective for all Australians.

The recently elected Australian Labor Party prides itself as the party of Medicare, the party responsible for the latest major reforms to the health care system.

Our appeal to this new government is to be brave and not to relegate the fixation of the Australian health care system to the hard basket. Our appeal to the people, the consumers of healthcare in Australia, is to please get in touch with your newly elected members and make sure they know how important healthcare is to you and your family.

The health system we have now is not normal, not fair and not safe, but with leadership it can be solved.

dr. Clare Skinner is an emergency physician and president of the Australasian College for Emergency Medicine

Originally published as Dr. Clare Skinner: Every part of the health system needs to be reformed to put patients first

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