With the tit-for-tat barbs surrounding ‘bed block’, communication has become a spectacle of defense not a strategy towards solutions. There are issues that deserve to be respected with simple bluntness.
The Australian Medical Association’s NSW President Dr Fred Betros has stepped up to do that in the NSW context. Seniors are stuck in hospitals and they shouldn’t be. This crisis is impacting thousands of others – and it shouldn’t. In the push for reform, blame for patients and physicians doesn’t move towards solutions, common sense funding does.
Delayed hospital discharge – the aged care facts
Being stuck anywhere is the stuff of Hollywood’s most unnerving horrors, and the shoe fits for NSW’s health and aged care system.
Betros starts with a simplicity of figures, “more than 1,300 patients in NSW hospitals are medically ready to be discharged today but cannot get the aged care or disability support they need. NSW Health modelling predicts 3,000 within six years.”
Perplexingly, physicians are feeling the strain to persuade funding decision-makers of the crisis at hand. The data is in, people are stuck in hospitals. The situation is serious, and the consequences are compounding.
Aged care’s bed blocking limits options for block discharge, not people
His perspective as a person, experience as a surgeon and authority as an AMA leader align. Betros is clear, “these patients are not to blame”.
It is a simple case of need, “some need help to shower, dress, eat or move safely” and, how we all would want to be treated, “you cannot send them home without that care.”
“But leaving them in an acute hospital bed for weeks is not right for them either”, says Betros, “it means someone else cannot move out of emergency, another patient waits for an operation, and the pressure spreads through the hospital.”
Limited options means being stuck. Not in a basement, but a hospital bed. This is NSW Health’s worsening operational-pathology.
Commonwealth aged care funding crisis
Worsening pathology does not happen in a vacuum. For Betros and countless peers, if infection surfaces, action is clear, and treatment must be applied.
The spreading pressure has a source. “This is due to a long-term failure by the Federal Government to fund an adequate number of aged care beds and NDIS supports. NSW Health does not operate in isolation. We must have support from the Commonwealth and we are just not getting it.”
“I see the results of this every day in my work as a western Sydney surgeon, and if something is not done about it, we will have a monumental crisis on our hands in the very near future.”
Hospital backlog is surgery curtailing or cancellation
Seniors in hospital beds, who do not want, or need, to be there, is not a political inconvenience for health professionals like Betros. It is a growing crisis, sharply and painfully brought into daily focus, through moral, health and professional decisions.
Betros has frankly called government messaging, that it has sunk enough investment into the issue, a “cop out”.
Expanding he says, “I called it a cop out because if enough had been done, we would not be in this crisis now. It is as simple as that.”
Physicians and patients are tired of the head-in-sand approach to this issue’s treatment, “this is not a new problem. The NSW Health Minister Ryan Park has been raising it for almost a year now.”
This is real-life and awful decisions, “I can tell you what it looks like in my own work. As a surgeon, we have been pushed towards day-only surgery in cases where I would prefer a patient to remain overnight – simply because there is no bed available.”
“[This crisis] means I cannot always make a decision that is in the best interests of the patient.”
Preventative care is effective Commonwealth aged care funding
Betros spells out the immediate treatment, “the Commonwealth needs to deliver the aged care places and disability supports that allow patients to leave hospital safely. NSW needs more doctors, nurses and properly staffed hospital beds, along with more public specialist outpatient clinics.”
But treatment of the issue can and must go deeper and smarter. Preventative measures have a powerful place in effective care and cost mitigation.
“We also need stronger general practice so people can see a GP before their condition gets worse”, he says.
“Both governments need to take prevention seriously”.
Betros highlights the simple maths, “if people cannot get care early, and patients who are ready to leave have nowhere to go, the pressure lands in our emergency departments.”
The maths of delayed hospital discharge is every demographic
“When people hear that one bed is blocked, they think one patient misses out. That is not how a hospital works.”
In the melee of bureaucratic barbs, some key maths has been missed. It is not one for one. The contagion has spread wider than that.
“If a bed is unavailable for several weeks, we could have used it for three or four elective operations, or four to five surgical emergencies, depending on the patients and how long they need to stay.”
A bed out of commission is people, of any age, or background, presenting to emergency and having care compromised.
“I see this when we are planning surgery. You can have the patient, the surgeon and the theatre ready, but if there is no bed for that patient afterwards, you cannot safely go ahead.”
For professionals on the ground, ‘bed block’ is not figures, it is faces. Faces of people, in beds, who do not want to be there, and, “[the] several patients waiting behind”.
