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Early indications for 2023 are that it will be business as usual – with access block and poor work conditions for our healthcare professionals. WA has just set the record of having seven of the worst eight hospitals for some ED care times, as published in The Australian, and our elective surgery waitlist has gone up by 80 per cent in the last 12 months. The acronym, SNAFU, comes to mind.

Eighty-five per cent has been identified as the best bed occupancy rate for efficiency (National Audit Office, 2013). When occupancy rates go over 90 per cent, the result is regular bed crisis (Bagust, 1999) and increased cancellation of elective surgery.
In WA, our hospitals are consistently over 90 per cent occupied, which sometimes increases to greater than 100 per cent – as we are all aware of the ‘over census beds’. Bed occupancy rates are also positively related to increased surgical mortality and overall mortality (Bosque-Mercader, 2022).

I will be asking the Health Minister’s office in 2023 to get WA Health to publish monthly KPIs, so that we can at least monitor more closely how the system is running. These KPIs will include:

• total beds
• total available beds factoring in staffing
• percentage bed occupancy average for all tertiary hospitals
• number of elective surgery cases done
• percentage cancellation of elective surgery
• waitlist lengths and types
• waitlists to see a specialist to get on a procedural waitlist
• number of patients spending greater than 24 hours in ED waiting for a bed
• ramping
• number of bed state black, bed state yellow
• number of obstetric bypass
• activity per capita of acute, subacute, mental health.

In 2022, I lobbied heavily and called for the McGowan Government to adopt a policy to reach and maintain the national average of beds per head of population. That way, we would at least have a fighting chance of reducing access block. This, of course, would also go along with measures to result in more efficiency, better patient placement, and better support for primary care to have a healthier society and less chance of re-admission.

Although the call has not been adopted, it has also not been openly rejected.

I have suggested that we need more beds in the system as part of a multifactorial approach to increase capacity. It can be argued that we don’t need more beds, but more ‘free’ beds. The point is made that the major determinant of free beds is, in fact, the total number of beds.

As I sink further and further into an episode of Utopia or Yes Minister, I face the question of who is right or, more importantly, who is wrong.

If I am wrong, WA will have spent more money on beds that we are going to need in the future anyway. If the ‘free bed’ advocates are wrong and they attempt to fix the problem of access block without a significant increase in total beds, then the people of WA will continue to suffer higher hospital mortality rates, and more cancelled elective surgery with longer waiting lists and ramping, until the lack of beds is corrected.

SNAFU or FUBAR?

SNAFU is an acronym from the American military that was used in World War II. Slightly modified, it stands for Situation Normal: All Fouled Up. The original had a slightly fruitier version of the F. It describes an ongoing undesirable situation that the foot soldiers can do little about, but have to endure. Our next state election is not until 2025. The one-sided political landscape is set until then, and probably another three years after that.

The McGowan Government is in no danger of losing the next election. Both the Nationals and Liberals have recently elected new leaders, as the pressure grows on two parties with little more than a handful of seats between them.

The Health Minister has been in the position for more than a year now, and the honeymoon period is over. What we need is a coordinated and funded plan to at least stop the rot, and preferably lift our state medical system out of the proverbial.

Unless we get such a plan, our system is in danger of heading further south, and may approach FUBAR – a similar military acronym that modified stands for Fouled Up Beyond All Recognition. Again, the original had a slightly fruitier version of the F.