Frank and fearless advocacy never more important | AMA (WA)


AMA (WA) | Dr Andrew Miller

Frank and fearless advocacy never more important

Tuesday January 5, 2021

Dr Andrew Miller AMA (WA) President

At the start of 2021, with vaccines on the horizon, Australia has demonstrated its ability to control SARS-CoV-2 via border control and lockdown. We still, however, see stark and unresolved problems with the preparedness, capacity and performance of state health systems, aged care and primary care.

The biggest success in our healthcare response has been the introduction of telehealth with associated MBS items, and it is good to see that the AMA took a central role in ensuring these changes will be permanent and sustainable, and that doctors have been flexible and agile in adapting their practices. This will take some tweaking to get right, especially for regional General Practice, but patients and practitioners enjoy the flexibility and this new practice is now part of the culture.

Public health services in WA are struggling to cope with business as usual. People are having adverse outcomes as a result of ambulance ramping and system delays due to lack of capacity, which is predictable, long-term and frustrating. There are a number of reconfigurations in progress, such as King Edward Memorial Hospital/Osborne Park Hospital, Royal Perth Hospital/Bentley Hospital and Peel Health Campus, adding extra stress to an already marginal system. We saw this as Princess Margaret Hospital (PMH) prepared to move to Perth Children’s Hospital (PCH) and hope that KEMH’s reconfiguration will not result in similar failures. So, we will watch and report on that closely.

The AMA (WA)’s Hospital Health Check has revealed poor results in many hospitals, some worse than others, with basic needs of our hard-working junior doctors, such as leave and exam preparation time, going unmet. The Enterprise Bargaining Agreement in that context has become a battle to shift the culture from management treating doctors as dispensable, to one of mutual respect and transparent, fair processes.

Members and the AMA (WA) Council are determined to provoke a reset and meaningful improvements through the EBA. The basics such as access to leave entitlements, and ongoing employment for consultants to match the other states should be offered by the Director General of WA Health as a matter of course, and he should show leadership, especially at a time of pandemic, to ensure the workforce is looked after.

The spectre of contract non-renewal is a very important disincentive to contributions to safety and innovation by individuals. ‘Keep your head down and don’t question management’ is not a safe or efficient way to run a health system, but it is the result of a combination of unfair contract arrangements and lack of accountability for some managers who lack the training or disposition to look after their workforce properly.

Having a popular state government is a natural outcome of a healthy economy and the avoidance of COVID-19. Democracy, however, relies also on effective media and opposition. With the recent elevation of Liberal Shadow Health Minister Zak Kirkup to Opposition Leader, there will be some new life and interest in the March 2021 election campaign.

The AMA (WA) is non-partisan and we will analyse all health policies and provide thoughtful feedback, as well as suggestions of areas for improvement to all parties.

Our COVID-19 advocacy, as with all issues, happens through many public and private channels and we see our main role as being a mouthpiece for you, the frontline doctors. We are seen by the community as an independent voice, as we do not have to spin the decisions and events in any political or self-serving way. We have praised the McGowan Government where it has been effective and sensible, but equally chided politicians and bureaucracy where decisions or implementation have been poor.

I have been particularly critical of the federal Infection Control Expert Group (ICEG) guidelines and want to make it clear this is in no way personal. It is an attempt to remind everyone that workplace safety is not a matter of infection control opinion; it is a legislated requirement to take all reasonable precautions to avoid risks in the workplace. It is not a matter of balancing resources against safety, as there is effectively no limit to the resources available to the government to keep workers safe. Just as in the mining sector, work should not proceed until the workplace is safe.

As there are conditions, particularly crowded indoor facilities with poor ventilation, where even ICEG acknowledges airborne spread, respiratory protection should be provided to frontline staff, as it is in many successful countries. Singapore has zero workplace spread, while Victoria had to close several hospitals and infected about 2,600 healthcare workers, not including non-clinical staff.

This is avoidable and dangerous, so that is why we have been vocal about it. Fit-tested respirators, and perhaps better ventilation to reduce the likelihood of airborne spread are coming to some health services in WA in 2021. Until then, our only hope for keeping aged care and hospitals safe is radical suppression by border control and if required, lockdown. I suspect we will get vaccines before our workplaces are made reasonably safe but we will continue to try.

The AMA (WA) Council and wider membership have been a source of great wisdom and many have individually brought perspectives and initiatives that as a whole have made the AMA (WA)’s contribution to the COVID-19 response a very important one, in my view. It is gratifying to see our contribution acknowledged in the new WA Museum COVID19 exhibit. The next year will no doubt be a roller coaster and as vaccination rolls out, we will need to be very careful to avoid falling at the final hurdles.

Thanks to Dr Bennie Ng, our CEO who has had an outstanding and no doubt unforgettable year in his new role. The Board, Council and I are proud to have someone of his calibre to lead change internally and represent us professionally externally, and we thank him and his partner Olivier, and the rest of our great team for all they have sacrificed in 2020 to set us up for success.

Our events have been modernised and diversified and I enjoyed presenting the annual AMA (WA) awards at our end-of-year function recently. Try to get along to an AMA event soon – there will be lots of new and interesting options to choose from and socialise with your colleagues and friends.

Rest assured that the AMA (WA) is determined to contribute as much as we can to you and your patients in 2021. Science and compassion are our profession’s foundation, and you deserve to be appreciated and valued by the community for all the skill, dedication and kindness that you put into keeping people healthy.