The State Budget: The real cost to health

The State Budget: The real cost to health


Dr Omar Khorshid
AMA (WA) President

Tuesday 21 May 2019

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The 2019 State Budget represents a significant achievement (and some good luck) for the WA Government and Treasurer Ben Wyatt. There has been real discipline when it comes to spending and it is clear that the Treasurer is proud of the fact that he has delivered a budget surplus after only two years in government. 

 

However, the spending restraint has come at a cost. In the health sector, spending growth has been markedly lower than the preceding decade and essentially flat when inflation is taken into account. This coincided with the creation of separate Health Service Providers (HSPs) and the opening of new hospitals such as Fiona Stanley, Midland and Perth Children’s hospitals. The combination of budget restraint and the disruption that the organisational changes inevitably caused has led to a pressure cooker environment in our metropolitan public hospitals.

 

Over the last few years, we have seen significant cultural and organisational issues spill out into the media at some of our major hospitals and the AMA (WA)’s Clinical Engagement and Morale Survey of senior doctors in 2017 clearly demonstrated the extent of the problem.

 

At the same time, the Doctors in Training Committee’s annual Hospital Health Check contains some good news and a strong lesson for HSP Boards – if you invest in your medical workforce and their well-being, engagement and morale can improve quickly. We know this translates to better, safer and more efficient patient care.

 

Despite $8 billion in capital investment, our public hospital sector remains well below the required capacity and the evidence for that assertion is everywhere – record ambulance ramping figures, poor Four Hour Rule performance, growing elective surgical waiting lists, and growing outpatient clinic waiting lists.

 

This means HSP boards and executives have a wicked problem – how to deliver on access targets in a setting of increased demand and flat funding? Part of the answer lies clearly in innovation, but we need to create the space for innovation to occur. That means investing in public hospital capacity to alleviate the current pressure at the same time as investing in longer-term strategies to manage the increasing demand. 

 

It is unlikely that solutions to long-term issues are going to come from health services that are busting at the seams with patients and staffed with burnt-out doctors who don’t trust the managers tasked with achieving impossible targets.

 

Before the budget, the AMA (WA) called for an increase in hospital funding to help take some of the pressure off after years of restraint. The increase delivered is too small to make a meaningful difference to patients attending public hospitals.

 

The government has been asking the health sector to await the results of the Sustainable Health Review (SHR) for a long-term plan for health service delivery in WA. A small amount of money was allocated to SHR implementation in the budget, but we will be waiting a long time for a detailed plan and implementation of any long-term solutions seems a distant dream.

 

In the meantime, it is the role of government to support our hospitals to deliver safe and effective care to our community. The AMA (WA) will continue to hold it to account. The government may need to learn the hard way that voters value their healthcare more than new trains.

 

On the positive side, the AMA (WA) congratulates Health Minister Roger Cook on the announcement in the budget of $52 million (new money) to support research and innovation in the health sector.

 

Importantly, creation of the enduring Future Health Research and Innovation Fund requires legislation to pass Parliament in order to access the $1.3 billion WA Future Fund. The AMA (WA) calls on all parliamentarians to support the passage of the required legislation. This announcement represents a great win for the AMA (WA) after six years of advocacy for greater support for medical research in our State. We see too many young researchers leaving WA and our State continues to attract only half our fair share of NHMRC funding. We need to sow the seeds of a vibrant medical research industry and the announcement in the budget is a significant milestone.

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