Queenslanders will soon be headed to the polls in an election that has many Australians watching to see the verdict on the Newman Government and others querying the role of federal politics if the anticipated swing against the LNP eventuates.
Readers may be interested to look at this fascinating analysis of twitter activity by Dr Axel Bruns of the QUT Social Media Research Group for a less traditional insight into which way things may be headed.
Croakey will be running a series of articles on key issues for the election in a Queensland votes series. In this post Professor of Health Services Management at Griffith University, Gary Day looks at some of the issues for safe and effective health services.
With the looming Queensland State election there has been little policy or major announcements from either of the major parties. While there is currently a policy vacuum, it is timely to have robust debate about the types of public health services we really need and can afford.
Whichever side of politics is successful come the end of January, the provision of sustainable public health services will be a critical ongoing issue for the government. Most critically, how does the government balance access with the quality of care?
With the approaching Queensland State election, one health consideration for consumers is the concept of access to clinically-appropriate hospital services, particularly Emergency Department (ED) services.
A recent example of this is the National Emergency Access Targets (NEAT) or better known as the ‘4-hour target’. The ‘4-hour target’ measures the percentage of patients admitted, discharged or transferred from EDs, Australia-wide. The policy was essentially aimed at increasing ED turnaround times and reduce ‘ramping’ (ambulances parked outside with non-admitted patients waiting to be seen).
The initial policy, introduced by the Gillard Government, was meant to see hospital EDs achieve a 90% benchmark by January 1 2015, in return for reward payments. This politically-driven policy was both a carrot and stick approach to improving hospital (and ED performance).
While the research is not conclusive in determining whether 4 hours is the optimal turnaround time, the policy largely worked. A study published in the Medical Journal of Australia (Maumill, Zic, Esson et al, 2013) demonstrated that over a three year period under the NEAT policy, there was improved timeliness of patient care throughout the hospital, in both the inpatient wards and the ED and there was no adverse impact on quality and safety of clinical care.
So why would this national health policy that is largely working be a Queensland election issue?
Because in last year’s Budget, the Abbott Government withdrew the incentive payments. Despite the clinical evidence to suggest the policy benefits the patient and the health service, with a lack of political ‘stick’, State governments have no financial incentive to continue to monitor or address falling target times.
Without the Federal reward payments, it is easy to see a return to longer waiting times in ED, ambulances being used as makeshift holding rooms and a fall in the quality of clinical care and outcomes. Queenslanders expect a lot (sometimes too much) from their public services, and longer waiting times will not be seen favourably by the electorate.
Whichever government is elected in Queensland, they need to look at appropriate use of services (EDs) and how clinically appropriate services can be provided without the additional Commonwealth finding. Approaches need to be found and researched that reduce hospital pressure points (such as EDs), while ensuring patients can receive a level of care commensurate with their condition.
For their part, Queensland consumers, need to reduce their reliance on EDs as a one-stop shop for all manner of minor and chronic conditions and complaints. Hospitals and particularly EDs are expensive to operate and are not used to their maximum effectiveness if overcrowded with sub-acute presentations.
Part of the issue with waiting times, ramping and overcrowding can be partially attributed to the ED being used as a general practice service for sub-acute and chronic conditions that would otherwise be seen and treated successfully in the community through the patient’s GP.
The incoming government needs to look at better co-ordination of sub-acute services and partnerships with GPs and other services to ensure patients receive the most appropriate clinical care in the most appropriate setting.
Reducing pressure on Emergency Departments starts with better integration of care across community and hospital services and trying to find approaches that allow patients with chronic diseases (such as diabetes, cardiac, respiratory and mental health as an example) to stay out of hospital EDs unless absolutely necessary.
In this way, EDs can deal with acute episodes of illness, accidents and trauma; with outreach services partnering with GP services to focus on chronic disease management.
The government of the day needs to realise public health services do not start at the ED door, rather it has a responsibility to better co-ordinate and integrate care across the community.
Ongoing funding and support for these approaches will afford Queenslanders with a much more comprehensive and linked set of services that are less reliant on Federal Government funding.
Professor Gary Day is a senior health executive with over 30 years’ experience as a consultant, project manager, director and chief executive officer as well as a clinician, academic, researcher and author. Gary has worked in both the for-profit and the not-for-profit healthcare sectors across three Australian states and in the higher education sector, including project lead roles in major infrastructure and change management, and organisation-wide roles in workforce development and learning and medical education.