But COVID exacerbated the health crisis. It didn’t start it. Australian Medical Association state president Dr Roderick McRae says Victoria’s healthcare system had been in “dire straits” long before the pandemic hit.
Hospitals have been underfunded for years,he says,leading to bed and staffing shortages. Problems with the federal government-administered National Disability Insurance Scheme and aged care have not helped – patients are stuck in wards waiting for mandatory assessments to enter both systems,locking up hundreds of hospital beds every week. The latest figures show the Commonwealth only puts in 36 per cent of the total cost of public hospitals,while the state pays 57 per cent.
Other patients,meanwhile,including those who are suicidal and psychotic,spend days waiting to be admitted through emergency department cubicles.
Victoria now has more patients than ever before and they are sicker. Emergency departments treated 479,719 patients in the last quarter,an increase of 34 per cent over the same period last year. And people who deferred having a check-up during lockdowns are now experiencing more complex or critical problems.
McRae says:“We’ve seen the population in Melbourne double in the last 10 to 12 years and the bed numbers and hospital services just haven’t kept up. The pandemic has just further exposed every hole that was already there.”
‘Hot’ wards and short shifts
Since the end of the second wave,Victoria’s COVID caseload has been relatively light,but its mere existence presents a serious challenge. Virus exposure in a single hospital can filter across the entire health system. If staff are furloughed and patients diverted to neighbouring hospitals,it adds to demand on workers.
This played out at the Royal Melbourne Hospital last week,when 450 staff were forced into isolation after a COVID-infected man,who wasn’t tested before surgery,sparked an outbreak at the Parkville facility. As authorities scrambled to contain the cluster,emergency staff were put in place and ambulances diverted to other hospitals for all but the most serious cases.
A nurse at the Royal Melbourne Hospital,who spoke toThe Ageon the condition of anonymity as she was not authorised to speak publicly,said staff were frustrated that the patient had not been tested before his surgery or even in the days afterwards.
“How can a patient be in the hospital for 10 days infecting staff and they haven’t even been screened for COVID? It just defies logic and belief. It has caused a huge amount of anxiety among staff.”
The nurse said the trauma ward at the hospital had been a deemed a “hot” ward,leaving dozens of staff working in a suspected COVID ward without any warning. “The anxiety levels are so much higher this year than they were last year because there are many young nurses who are seeing younger people get infected and come to hospital,” she said.
Across Victoria,managers say they are struggling to fill shifts,partly because nurses have been deployed to every corner of the COVID frontline as contact tracers,vaccinators and testing centre staff. Health unions warn of unprecedented rates of double shifts and dangerous levels of burnout,including in maternity wards,where women are being reportedly discharged early from hospital only to return with complications.
Australian Medical Association president Dr Omar Khorshid is reasonably confident that every COVID patient who needs an ICU bed or ventilator will get one. But he said he wasn’t seeing any preparations to be able to continue normal healthcare at the same time.
“What I’m more worried about is all the other healthcare that gets stopped or pushed aside in order to look after COVID patients. And that is what we’re seeing right now in Sydney,we’re seeing it in Melbourne,we’re even seeing elective surgery cancellations in Perth,prior to any COVID because the system is so full,” he said.
Patients are raising concerns about the quality of care. Box Hill resident Julie Rowland*,an 84-year-old widow,was last year one of thousands of Victorians sent a taxi instead of a paramedic to transport her to emergency as part of an Ambulance Victoria overhaul designed to free up vehicles from taking on non-urgent cases.
She was alone in her home at a Box Hill retirement village one night when she started to panic that she was having a stroke. “I couldn’t use my fingers properly,I couldn’t speak properly and I was having trouble walking,” she tells The Age.
What followed would be laughable if it wasn’t so serious. At first the taxi driver struggled to find her address,then he had trouble finding Box Hill Hospital,only a short distance away. Once they arrived,nobody helped her get inside.
“All I could think about was:what if something had gone wrong from here to there?” she toldThe Age. “What if I’d had a stroke? What was the cabby going to do when he didn’t even know where the damn hospital was?”
The mental health toll
Melbourne psychiatrist Dr Killian Ashe says there has been an “extremely concerning” increase in people,especially children and young people,presenting to emergency departments with self-harm and mental health distress. A growing number use drugs and alcohol to cope.
Some in the midst of a crisis spend two or three days waiting in emergency departments because no mental health beds are available.
“Services are so saturated,both public and private,” he says. “It really should very rarely come to a person having to present to an emergency department,but unfortunately now it almost always comes to that.”
The problem is exacerbated by a severe shortage of mental health workers and beds. Some nurses have become so burnt out they’ve opted to leave mental health wards and take jobs helping with vaccination and testing.
”Striving towards the best vaccination numbers and keeping people safe from COVID is an awful necessity,but it is the only way out of this,” Ashe said. “But this mental health pandemic that’s coming with it is carrying more morbidity and mortality now,arguably,than actual COVID itself.”
Ashe said a faster immunisation program was urgently needed along with more funding to deal with the mental health toll of pandemic stress.
Psychologists are also feeling the pressure as they try to help a growing number of young people who often have to wait months for a referral. Calls to the child counselling service Kids Helpline increased by 30 per cent in the first six months of this year compared to the same period last year.
“Children’s needs aren’t being met ... and you’ve got all these desperate parents really wanting support for their kids and getting frustrated because they feel like they can’t get the help that they need,” says Rebecca Thomas,co-founder of Shine Bright Psychology,which caters for school-aged children. “That puts a lot of pressure on psychologists as well because we have this huge influx of work that we just can’t keep up with. We simply don’t have the workforce.”
No simple fix
As demand for health services soars,the question is whether the system can withstand the pressure. And as state and federal leaders squabble over national cabinet vaccination targets to ease lockdowns,what must be done to safeguard hospitals once Australia eventually begins opening up?
TheAndrews government has invested $759 million to recruit more than 300 paramedics and registered nurses,to implement a new transport service for patients who do not require urgent care and to boost triage and telehealth. About 350 medical staff have also been recruited from overseas and will be deployed across 30 health services from October.
But Danny Hill argues the health system “needs to work like an ecosystem” – you can’t unclog one part without fixing another.
“You can double the amount of ambulances but if you don’t have the beds on the wards for patients to move into,and if we don’t have enough allied health people to discharge patients,then it won’t work.”
Psychologists and mental health services have also asked for additional resources,while Australia’s leading doctors’ groups are demanding state and federal governments commit to establishing an emergency plan to avoid the system “grinding to a halt” every time new COVID cases emerge.
This plan could mirror emergency medical responses already in place to handle natural disasters such as bushfires or floods,says emergency medicine specialist Dr Sarah Whitelaw. Once hospitals have hit a certain threshold or a certain percentage of staff have been furloughed,it would trigger a statewide response so entire hospitals are not shut down.
Cognisant of the challenge,Prime Minister Scott Morrison has promised to “bolster” the nation’s hospitals and make sure the system has the “resilience” to cope. He is yet to explain how. The government has sought urgent advice from intensive care doctors about what happens after the country hits a vaccination rate of 70 per cent or more and starts easing restrictions. At that point,doctors expect already stretched hospitals will experience a huge and sustained boost in demand from a COVID-19 pandemic of the unvaccinated.
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A national working group has also been convened to address issues highlighted by the pandemic which include national funding arrangements,reforms to care models and workforce fatigue – but the jury is still out on what it might achieve.
“It’s not going to be an easy,simple fix,” says Andrew Hewat,assistant secretary of the Victorian Allied Health Professionals Association.
“The workforce has been run too lean for too long,well before COVID. The pandemic has really just exposed the vulnerabilities of the system.”
With Rachel Clun