Fixing Victoria's healthcare system
The pandemic showed us the cracks in our healthcare system.
During January the health crisis dominated the news, with daily reports of a hospital system barely able to cope with an influx of people struggling to breathe as COVID attacked their lungs.
No part of our health system was spared as staff shortages worsened and the virus raced through the community.
As the number of COVID hospital patients declines and the sense of crisis eases, we should take this opportunity to think about how we could improve our health system, so it’s not always struggling to cope.
That’s why I’ve asked people in my electorate to tell me about their personal experiences with the health system and what they value most in a health system.
But here’s a quick outline of some of the problems that affected our healthcare system, as I see them. (I’ve deliberately omitted the disease control aspects, like contact tracing, lockdowns, masks and vaccines, as they need a separate discussion.)
Our ambulance and hospital system struggled to expand to accommodate a surge in COVID patients, particularly during the Delta and Omicron waves.
Nurses were called on to work double shifts and to care for larger numbers of patients. Wards struggled to find staff and couldn’t take new patients.
Emergency departments filled up with patients waiting to be admitted to those wards, so they couldn’t take patients from the ambulances which kept arriving. So ambulances were kept waiting in hospital driveways, functioning as pseudo-emergency beds.
In effect, staff shortages throughout the health system led to ambulance 'ramping' and consequent ambulance delays.
Staff shortages were particularly severe in all workplaces when Omicron peaked, including parts of the health system not obviously connected to the pandemic, such as maternity care.
Postponing elective surgery did free up nursing and junior medical staff for COVID work, but this cannot be sustained for more than a few months per year because elective cases become urgent and because the backlog becomes unmanageable, as it is now.
What about people who weren’t sick enough to need an ambulance? Thousands of people have become very ill without requiring a hospital bed.
'Primary care' refers to the local clinic people attend when they fall ill and in Australia that’s usually a private GP clinic – a general practice subsidised by Medicare from the federal government. The GPs may be partners in a small business, or work for a partnership owned by colleagues.
These days many GPs work for corporations that own chains of clinics. GPs are employed as contractors, and keep a percentage of their fees. Other GPs work in partnership arrangements, or for a partnership.
However they may be employed, GPs are usually the first stop for a sick person and may already have a relationship with them or their family. This is particularly important for people from different cultures or language groups, the groups worst affected by COVID in the winter of 2020.
But the state has little to do with GPs. It doesn’t have teams of GPs available, so during the pandemic, private companies and community health organisations were used to supply GP services.
The state set up respiratory hubs, testing centres, and vaccine hubs, roles usually filled by primary care.
When Delta hit, younger adults were not fully vaccinated and many became quite ill, while not requiring a hospital bed. Many young adults are not connected to a GP, are deterred by gap fees, and busy general practices were often closed to new patients.
The “COVID positive pathways plan” was initially run by Co-health (a community health organisation). Under this plan, health workers including GPs called people diagnosed with COVID to determine if they might need urgent medication or hospital care in the home, or could be safely monitored from their home.
Our primary care system was neglected by the federal government and many general practices actively discouraged suspected COVID cases from attending, often because they didn’t have the facilities to separate infectious patients from their other, often vulnerable patients.
The gap between federally-subsidised private primary care (GPs) and state-funded public hospital care has always caused problems in our health system, but it became a chasm during the pandemic and remains a real challenge.
Maybe the pandemic will force us to take another look at this and other long-standing flaws in our health system.
For over a decade we’ve been troubled by long waits for specialist outpatient clinics in public hospitals, long waits for elective surgery, 'bed block' and ambulance ramping in emergency departments during flu seasons, complex patients 'bouncing' back into hospitals after being discharged to the care of their GP, under-funded public dental care for people on low incomes and a public mental health system starved of beds and staff.
The public mental health system will get a boost as the mental health Royal Commission findings are put into action. But do we need some kind of inquiry or commission for the rest of our health system?
I don’t know yet, but I’m keen to read the suggestions from people living in Brunswick and surrounding suburbs because a healthcare system needs to be guided by the values and needs of those it serves.
