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Cash-strapped hospitals falling short of treatment targets

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Public hospital emergency departments are falling well short of national treatment targets despite recent improvements, deepening doubts that they will be able to achieve substantial improvements in performance without a major boost in Commonwealth funding.

Figures compiled by the Australian Institute of Health and Welfare show that 73 per cent of emergency department patients were admitted, referred or discharged in four hours or less in 2013-14, up from 64 per cent in 2011-12, but far short of the 90 per cent target set for 2015 by governments under the National Partnership Agreement.

The best performing State, Western Australia, has to achieve an 11 percentage point improvement in little more than 12 months if it is the reach the target, while New South Wales has to deliver a larger 16 percentage point lift and the ACT and the Northern Territory, the nation’s two worst performers, face an even more improbable 28 percentage point gain.

While the National Emergency Access Target is expressed in terms of calendar, rather financial, years, the results underline warnings from the AMA earlier this year that recent improvements in emergency department performance were being put at risk by Commonwealth finding cuts, and that hospitals would struggle to reach the national performance benchmark.

In the Budget, the Federal Government stripped $20 billion from public hospital funding in the next five years by disavowing funding guarantees made under the National Health Reform Agreement in 2011 and scaling back the indexation of its contributions from mid-2017 to the consumer price index and population growth rather than the higher efficient growth dividend.

The Commonwealth cutbacks come despite relentless growth in demand for public hospital services.

There were almost 7.2 million presentations to public hospital emergency departments in 2013-14, a 7 per cent jump from the previous year, and equivalent to almost 20,000 presentations a day.

The health system’s ability to respond effectively to medical emergencies was demonstrated by the fact that virtually 100 per cent of patients in need of resuscitation received immediate treatment, while 82 per cent of emergency patients were cared for within 10 minutes.

But this responsiveness has come at a cost for patients with health problems that demand less immediate attention – less than three-quarters of urgent and semi-urgent cases were seen on time.

Overall, patients faced a median waiting time of 18 minutes to be seen, and the median stay in emergency departments was two hours and 40 minutes.

AMA President Associate Professor Brian Owler said the gains that had been made in giving attention to patients more quickly and freeing up beds in other parts of hospitals to enable admission from emergency departments, had been as a result of the hard work of health workers and specific payments from the Commonwealth to the states and territories.

“The improvements reflect the efforts of the dedicated and hardworking doctors and nurses working around the clock in our emergency departments and in the other areas of the hospitals that need to work efficiently to allow patients to be admitted from emergency,” A/Professor Owler said.

But he said prospects for any further improvement had been undermined by the Commonwealth’s cut to funding.

“There has been a significant reduction in funding guaranteed for public hospital services in the National Health Reform Agreement,” he said. “This means that there is no certainty that hospitals will be able to maintain capacity to reach the four hour target of 90 per cent by 2015. Public hospitals are a vital part of our health system. They must be properly supported, and that means more funding, not less.”

While emergency departments have improved their performance, elective surgery waiting times have stagnated.

The Institute has reported that half of all patients listed to undergo elective surgery in 2013-14 were admitted within 36 days – the same proportion as in 2010-11.

The speed of admission has remained steady despite a 4.2 per cent jump in the number of people listed for undergoing elective surgery last financial year to almost 700,000 patients, though the increase has been driven by population growth, as evidenced by the fact that the rate at which elective surgeries are being performed has remained unchanged at around 30 admissions for every 1000 people for the last five years.

Patients waiting for coronary artery bypass surgery faced the shortest average wait (18 days), while those listed for treatment to correct a deviation or dislocation of the septum of their nose encountered the longest average delays (221 days).

There has been a slight reduction in the proportion of patients facing very long waits for elective surgery – the proportion experiencing a delay of more than a year fell from 3.4 to 2.4 per cent between 2009-10 and 2013-14.

Overall, 90 per cent of patients on waiting lists were admitted within 262 days in 2013-14, a slight improvement from 265 days the previous financial year.

Adrian Rollins