We have 38% fewer hospital beds than in 1981: it’s a scandal
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Governments of all persuasions have tried to limit health expenditure by cutting hospital bed numbers, in the mistaken belief that less beds mean more efficiency. The result — not enough hospital beds available for the needs of many very sick patients. Around Australia, this lack of beds in the wards of public hospitals results in frequent Emergency Department “bed block”, ambulance “bypass” and postponed elective surgery. In Australia we have 38% less beds than in 1981 when there were 6.4 acute care hospital beds for every 1000 people. There are now only four beds per 1000 people available. Only 2.7 of these beds are available in the public sector — where the sickest patients are looked after. In the ACT the situation is worse. There were only 2.3 public hospital beds available per 1000 residents in 2006-07 and we need to take into account that around 25% of these public hospital beds are filled by NSW residents. This effectively means there are only about 1.7 public hospital beds are available per 1000 ACT residents. By far the lowest ratio in Australia. It is likely that the National Health and Hospitals Reform Commission report, whose release is expected shortly, will rightly put much emphasis on improving and strengthening primary care, but it is important that the need to improve hospitals’ capacity is not overlooked. When there is a lack of beds, patients suffer. More complications and even deaths occur. Many are left in Emergency waiting rooms because too often there are no beds available to care for them. In those left at home, necessary surgery and medical therapy is delayed because there are no beds available to which they can be admitted. Some patients already admitted in smaller hospitals might require transfer to tertiary referral hospitals for more appropriate care but spend many days waiting for a bed to become available. This also means that their appropriate higher level care and therapy is delayed. When you run a hospital at close to 100% occupancy, this makes hospitals less efficient — not more efficient. When full, there is no flexibility to move patients to the wards or areas that is most suitable for their care. They have to take a bed anywhere and then be moved (often multiple times) around the hospital until they arrive in the area of most appropriate care. We need more acute care hospital beds. The number of beds we have available now too often fails to cope with the needs of those who are seriously ill and need to be in hospital. We need adequate numbers of appropriately trained staff to look after the patients in additional beds. While we can’t produce large numbers of appropriately trained staff overnight, Governments should be able to look at what our needs are likely to be in the future and ensure we train and retain many more nurses, doctors and other healthcare workers. This can’t be done overnight but with appropriate planning and implementation it can start having an effect within a few years. What number of beds should we have? No one can really be sure. But the number of available beds now is clearly not enough. A 20% increase (to five beds per 1000 population) would seem to the minimum improvement necessary and the level we had in the 1980s (six beds) a preferable key performance indicator to strive for. When we no longer have “bed block”, ambulance “bypasses” and when those people triaged as “urgent” or higher can get rapid access to beds, then we know we have go the bed numbers correct. It is time for all our political parties to give such a commitment. What is happening now in Canberra and around the country is intolerable and has to change. We need local and national targets for the number of adequately staffed acute care beds that should be available and then a concerted campaign over the next few years to make sure we get there. Professor Peter Collignon is President, ACT Branch of the Australian Salaried Medical Officers Federation. |
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12 Comments
That will explain why i’m waiting and waiting and waiting for a hip operation. Mean while getting stoned off my little brain on all the so-called pain killers the doctors keep prescriping for me. Oh well at least I’m getting legally stoned!
There have been significant changes in medical practice over the last twenty years. For example, if you had your appendix out in 1980, you probably stayed in hospital for 4-5 days. Now, you will be out in 2. A cataract operation which was done in 1980 required at least an overnight stay - now it is usually a day procedure. This means that if we were to do the same work that was done in 1980, we would need fewer beds.
The issues of “bed block” may also be related to staff shortages (rather than lack of physical beds), or to lack of particular kinds of beds (intensive care, coronary care).
Euan J Thomas -Is your operation classified as “elective”?I can’t understand how they’re allowed to get away with this.My brother-in-law required surgery for cancer several yrs ago, and it was classified as “elective”. It’s horrific that people have to wait so long, when being in chronic/acute pain is recognized as ruining people’s general health, including their immune system.
Of course, if there are more available beds around the country, are there the necessary doctor/nursing staff to care for them anyway? Cutting back on the number of people allowed to study medicine started before the Howard govt I believe, and Howard just made the problem worse. I heard last week that patient toilets were closed in a large hospital in NSW due to cleaning staff being off sick. Pity the poor patients who had to trudge up or down a floor to visit the loo or have a shower etc?I asked a stupid question, ‘why not employ more cleaners’?Silly me! There are people out of work aren’t there?
Would the hospital system be any better if the Rudd govt took over?I often wonder how much money is wasted in having duplicate administrative positions around the country. It would be interesting to know these costs! I’d probably be shocked, and I think I’m pretty well aware of the current position. It’s a miracle that there aren’t more deaths - maybe they just keep them quiet!
I also heard that a new hospital in NSW that has just opened has 2 less beds than the old one it replaced?I just wonder what idiots are in charge of making these decisions?
The reduction in ‘beds’ over the years has also led to the widespread implementation of mixed gender wards - a situation which represents an erosion by stealth of the dignity of patients, both male and female. No one wants to hear about it though - I think we’ve passed the point of no return on this one.
Having been involved in many campaigns opposing the closure of hospitals and hospital beds over the last 30 years, I have to say that Peter is right and he has health system administrator support for his views. I remember sitting at a table as a union representative a couple of years ago when a senior NSW Health administrator admitted that too many beds had been closed. I made him repeat what he had said a couple of times, while I luxuriated in being vindicated. It is true that there is far more day stay, outpatient, and hospital in the home work now, and that there are bed closures due to staffing shortages and the lack of availability of the appropriate skill mix, particularly in nursing. These staffing shortages are being addressed, with the current Federal Government far more committed to registered nurse education than the Howard Government who were rapidly moving towards the de-skilling of nursing no matter what the cost to the quality of care. But more needs to be done. Much more. And Peter’s objective of 5 beds per 1000 of populations seems to be a reasonable objective. I am presuming he means public hospital beds otherwise the ugly difficulty of accessibility based on health insurance status arises.
Tony is correct. W need the staff to man the beds. Hospitals all over Australia are suffering from a lack of staff.
After all who would want to spend sometimes 14 hours a day 7 days a week looking after patients for a pittance.
Give beete pay, get more staff, open more beds. Maybe it’s to simlpe to work.
The problem is corporatism where hospitals are businesses and in the end
no one is accountable for the quality & or quantity of service that is provided.
With Hospitals being a business as opposed to bering directly under the control of governments disempowers staff and institutionalises bullying so that the ranks of whistleblowers have thinned. Australia has become a more authoritarian society and the corporatisation of government funded institutions such as hospitals is a part of this turn to top down & anti democratic almost Stalinist type decision making model that has become more prominent, more prevalent and more damaging in the twenty first century where citizens have become clients who have few avenues to keep the people who run these organisations honest.
One interesting issue not raised by this article. Have the number of hospital beds that are in service been reduced in that hospitals have physically shrunk in size and number or is it that many hospitals have unused capacity ie floors and wards that have been deliberately being kept empty becasue it is ‘uneconomic’ to have these floors and wards and floors in service. If the latter is the case then this on one hand is terrible but on the other hand if there is political will by the citizens who vote and politicians who heed these votes then the number of beds in service could be increased fairly quickly.
I wondered why Prof Collignon picked on 1981 to compare bed figures. Does it have anything to do with 1981/82 being the last years of hospital-based nurse training? The student nurse population was relocated to the universities after then, and the health system employee numbers took a big dive.
Can anyone enlighten us on the outcome of the Howard Government’s attempts to bring ex-nurses back into the profession? Did the money get spent? How many experienced nurses came back? Anecdotally, I know more ex-nurses than I know working nurses, and all of them were unimpressed by the “come back to nursing” package. I’m curious to find out if the anecdote reflects the reality.
I was under the impression that it is available nurse numbers that dictate how many beds can be kept open. The loss of the student nurses caused a large number of beds to close after 1982, and that also might explain more about why people are sent home asap after some surgeries these days.
After a recent stay in post-natal for example, one midwife explained to me that they had a certain number of rooms always open, and two others that could be opened if they had enough nurses. They rarely did, so those beds were effectively unavailable even though they were there, made up and ready to go.
Cleaning duties were often undertaken by student nurses in the old system. One of the arguments to make nurse education university-based was that we should not be wasting their time with cleaning jobs. With the rise of economic rationalism, cleaning became outsourced to contractors. And that is why a hospital might have to close public toilets - they have no one else to clean them if the contractor’s staff are unable to work. They do not employ cleaners themselves.
The risks of cross-contamination are taught to nurses, but they are not taught to cleaning staff or many hospital administrators. We now have community-based MRSA, a vicious form of staph aureous resistant to most antibiotics. In 1981, this bacteria was solely the problem of the hospitals. We once had infection-control nurses, who only hunted down MRSA and contained it whenever they found it. Haven’t heard of them in a long time. Do they still exist? Are they still running around with swabs, or are those specially trained nurses reduced to writing dismal reports on the failure to contain it?
Finally, I wonder if we could be utilising our student nurses more often in the hospital setting? Most of those I have seen on work experience have something of a “uni student” attitude. They turn up late, if they turn up at all, and don’t seem too engaged with the (paid) staff supposedly training them. I’ve seen some awful tanties from students too, yes, in front of patients. That sort of behaviour wouldn’t have been tolerated in 1981 …
So that makes me wonder again. How do these youngsters go when they get to be nurses for real? What is the drop out rate now compared to the old system? Bigger? Smaller?
Hope I’ve provided you with some food for thought. Maybe someone more well informed can answer some of my questions.
Ross Cornwill: God! You are such a child. You know as well as I do that freeways going nowhere in particular, sports arenas which eat up what little parkland we have left, spending $100million to hold a spurious sports event in which the governments-State and Federal get back $35 million in tourists’ money, sending politicians at vast expense to countries as germane to Oz as Andorra, are all infinitely more important to our politicians than sick and dying people waiting to get into hospitals.
Venise
Ok you win. I leave a simple comment like others to be told I am “Such a child”.
You would reckon at the age of 61 I should know better.
Never again post a comment. Saves the comments like this one.
ROSS CORNWILL: My comment was meant in jest, as in irony. There was nothing personal in it at all.
Why on earth would abuse someone of being a child when, to my knowledge, this was the first time I had ever spoken to you?
If your reply was in jest then I apologize in advance. However I don’t think it would have looked at all sane to have started my comment thus…”Venise Alstergren: God! You are such a child. You know as well as I do that freeways going nowhere in particular, sports arenas which eat up what little land we have left”….etc. May have been an arresting sight but somewhat laughable by intent.
Just in case you haven’t got it. Try to realize the heading too would have spelled out my name.