To ‘stand up for WA’, Albanese and McGowan must focus efforts on hospitals



Nonetheless Labor has promised a trial of 50 urgent care clinics around the country to be located near emergency departments, modelled on a scheme that runs in New Zealand.

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Albanese also promised $970 million to “boost Medicare” in the final week of the campaign, $750 million to improve access to GPs including out of business hours and for the management of complex conditions, and $220 million for small infrastructure grants for GP practices.

The new health minister will also chair a taskforce a new primary health care strategy, which, if it is successful, should have preventative health as its primary goal, keeping patients out of hospitals.

Fifteen years ago Kevin Rudd promised to “fix public hospitals” within two years and if his targets for improved hospital waiting times weren’t improved, he’d hold a referendum for the Commonwealth to take over public hospitals holus-bolus.

That, like many Rudd aspirations, foundered and instead COAG, with the exception of Colin Barnett in WA who railed against a Canberra takeover, reached a deal where the Commonwealth would fund 60 per cent of hospital activity under a new national pricing system.

Rudd was rolled by Julia Gillard, who attempted to clean up the reform effort by doing first-mover side deals with any states who wanted to sign up.

In the end the states kept all their GST and their responsibilities, the Commonwealth stumped up more money, and reform ambitions were watered down though like many Gillard compromises, the outcome was workable and peaceable.

The election of the Abbott government saw Joe Hockey try to put the growth of health funding to the states on a “sustainable” (budgetary) trajectory with the Commonwealth offering to fund population and CPI-linked growth but no more, and not much interested in the details of what it might mean for individual states’ hospital systems.

Funding grew under this model, but less quickly than had been proposed under Gillard, which provided the basis for Labor’s attack that the Coalition had broken its pre-election promise of “no cuts to health”.

There was also the proposal for a $7 Medicare co-payment for every doctor’s visit – which was eventually scrapped because it was so unpopular.

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The prime minister changed again and Malcolm Turnbull essentially wrote a big cheque: the Commonwealth would meet 45 per cent of the states’ hospital funding needs, capped at an annual spending growth rate of 6.5 per cent through 2025.

That was all before the pandemic, which saw all sorts of prior constraints swept aside in the name of a national emergency.

In March 2020, Scott Morrison agreed to pay 50 per cent of additional COVID-19 costs incurred by the states, which set the stage for the latest funding squabble earlier this year, with the states arguing for the 50-50 rule to become the norm for all hospitals costs and the 6.5 per cent cap to be scrapped. Morrison said he wouldn’t play shakedown politics.

Behind its closed borders WA was blessed with the advantage of time to prepare for post-COVID realities, and record revenues mean budgets are hardly as constrained as they might otherwise be.

While hospital and ICU admissions have been well below what had been modelled, the system is still under immense strain.

Last financial year, 16 per cent of category 1 procedures were running later than the recommended 30-day clinical timeframe, up from 12 per cent a year before; and 23 per cent of category 2 procedures were running later than the target 90-day timeframe, up from 18 per cent.

Frontline practitioners blame incompetent administrators as workforce shortages are exacerbated by COVID furloughs and infection control practices dreamed up by head office without reference to clinical realities.

Amid it all, the ambulance service has been on the brink of collapse (and has become its own political football) because of furloughs and ramping, in turn caused because there is nowhere for the ED pinch point to go.

This is where Butler, Albanese, McGowan and WA Health Minister Amber-Jade Sanderson should sit down and work out new ways of doing things.

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Albanese is interested in policy by nature and it is a better co-ordination of the overlapping responsibilities – rather than business-as-usual funding squabbles – where potential solutions lie.

How do governments create the incentives to divert patients from the emergency room as a first resort?

How do they better co-ordinate aged care and hospital treatments so the sick elderly are not stuck indefinitely in tertiary hospital beds?

Similarly, where are the proper community-based mental health treatments and facilities that get people out of hospitals?

Will the governments prioritise tackling WA’s historic GP shortages once and for all?

And how do sustainable, targeted investments in preventative health – plus better, cheaper access to lower cost primary care – drive a healthier community that has less call on the most expensive care settings – hospitals – of all?

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