Patients know it – many of us have spent hours in waiting room chairs,hallways and overflow tents. Emergency nurses and doctors know it,too – they’ve been inundated with record numbers of the sickest patients.
And Health Minister Ryan Park knows it all too well.
“ED wait times keep me up at night,” he told theHerald last year. “Too many people have been forced to go into emergency departments because there’s not an alternative pathway.”
On the eve of a second Labor budget,two main strategies are beginning to emerge. The first is reducing demand by diverting patients away from overflowing emergency departments. The second is boosting the supply of frontline workers to cope with the demand.
But as demand has risen,so too has the cost of delivering healthcare. Hospital rebuild costs have blown out by hundreds of millions,the government has lifted a decade-long cap on public sector wages,and unions are negotiating new deals for tens of thousands of frontline workers who feel underappreciated and burnt out.
The government is having to spend big just to hold on to what they have. Turning the ship around will cost a lot more.
By the numbers
There were 792,841 visits to NSW emergency departments in the first three months of this year,the most of any quarter since the Bureau of Health Information started counting in 2010.
There were also unprecedented numbers of the most serious patients,with 6677 “triage 1” patients requiring resuscitation and 123,895 “triage 2” patients needing treatment within 10 minutes.
That means patients across the board are spending longer in emergency departments.
This is by no means a problem confined to NSW. In fact,compared to other states,our hospitals are performing relatively well.
In 2022-23,the most recent national data we have,74 per cent of people in NSW were seen within the target time for their triage category.
The next closest was Queensland,with 67 per cent of patients seen on time,and Victoria (65 per cent),with the remaining states and territories hovering around 50 per cent.
The problems can’t be blamed entirely on a growing and ageing population. Almost half of ED visitors are working-age people between 25 and 64,and the number of visits per 1000 residents has increased in the past five years,meaning demand is growing faster than the population.
How we got here
Park says too many people are using EDs as a first port of call for non-urgent issues because their local GP is unaffordable,unavailable or only open for limited hours.
The map above,showing bulk-billing rates as low as 5 per cent in some parts of Sydney,illustrates how dire the situation has become.
States are clearly angry that their hospitals are picking up the slack on aged care and the NDIS,too.
“We’ve got over 700 patients who are stuck in our hospitals who should be in either aged care or getting treated through NDIS support,” Park told ABC radio on Friday morning. “Those systems aren’t working.”
Park and other state health ministers wrote to the Commonwealth on Friday urging them to increase GP Medicare bulk-billing incentives and lift restrictions that limit the number of medical school places.
But doctors and nurses working in emergency departments say GP patients are not the ones who are taking up their time. A lot of them have been referred by their GP in the first place.
“Patients that can walk,sit in the waiting room … they don’t stay very long,they don’t require a lot of medical and nursing resources to sort them out,” says Dr Rhys Ross-Browne,a Sydney emergency doctor and the NSW chair for the Australasian College for Emergency Medicine.
Why it matters
Park has put workforce retention and access to primary care at the top of his government’s health agenda.
The government has rolled out 16 of its promised 25 urgent care clinics,complementing the 14 Commonwealth-funded urgent care clinics scattered across the state.
This year’s budget will include $100 million to fund these services as part of a half-a-billion-dollar package the government says will avoid an estimated 290,000 visits every year.
They will also spend $274 million hiring an additional 250 healthcare workers to increase staffing levels at new and upgraded hospitals and $20 million on 32 new paediatric allied health staff.
What they said
What next
The government is yet to broker a new pay deal with its public sector workers. Their offer of 10.5 per cent over three years has been met with anger by the doctors’ union. Nurses and midwives – the state’s largest group of employees – are demanding 15 per cent in one year.
The opposition says this will cost an extra $6.4 billion over the next three years. The government has already to fund increased public sector wages.
Anything above this will need to be offset by productivity savings,the government says. When nurses have watched their paramedic and teaching colleagues receive generous pay bumps,that could be a bitter pill to swallow.
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