New report shows McGowan Government must bring hospital bed numbers up to the national average | AMA (WA)


Hospital beds

New report shows McGowan Government must bring hospital bed numbers up to the national average

Wednesday November 9, 2022

Today the Australasian College for Emergency Medicine (ACEM) released State of Emergency 2022 (SOE22), an inaugural annual report that presents the numbers behind the healthcare crisis, using data gathered from across each of Australia’s states and territories during 2020 – 2021.

“It is the inarguable proof of what ACEM has been saying – with increasing urgency – for a very long time; the health system across Australia has never been in a worse state,” ACEM President Dr Clare Skinner said.

“There have never been more people requiring acute healthcare, people have never had such complex health needs and the health system has never been so strained. It is bad everywhere, but it is worse in rural, regional and remote areas.

“While these problems are deeply complex, and interconnected, at the same time the situation is frustratingly simple: there are too many sick and injured people, and not enough resources and trained staff, for people to get the affordable and accessible acute care they need, when and where they need it.”

This afternoon, AMA (WA) President gave a media conference in response to the issues raised in the report. Following is an edited transcript of the media conference.

Dr Mark Duncan-Smith: The report released today shows that WA suffers with a lack of beds and a lack of capacity. The AMA (WA) yet again calls on the McGowan Government to have an active policy to increase our bed numbers to the national average. WA started the pandemic with the lowest number of beds per head of population and the lowest number of ICU beds per head of population of any state or territory in Australia.

Doctors and nurses are sick and tired of trying to deliver safe and quality healthcare with one hand tied behind their back. The primary cause of ramping and bed block and lack of access to emergency care is a lack of beds in the system. We can chip away at the edges, trying to reduce demand and to increase efficiencies and outflow. But the primary problem is we quite simply do not have enough beds.

The standout figures from the report for me are that demand for the system and beds has gone up by 9 per cent over the last five years, but the supply of beds has only gone up by 2 per cent. That differential represents high occupancy of the hospitals, bed block, ramping and poor outcomes. The most efficient hospital is 85 per cent occupied. Once a hospital goes over 90 per cent, you get bed block, you get ramping, and you get increased death rates and poor outcomes. Our hospitals in WA unfortunately are frequently over 100 per cent occupancy, as evidenced by over-census beds.

Also, in the report it states that the emergency departments are meeting their targets for patients that get discharged home, so in other words, don’t need beds. However, they don’t meet their targets for patients that do need beds. This indicates it’s not an efficiency or a performance problem with the emergency departments. It is quite simply a lack of beds.

Reporter: Midland Hospital will soon be opening an ambulatory emergency unit (same-day services across a range of clinical areas as an alternative to in-hospital care). Armadale will soon be opening one. I think there’s one at Fiona Stanley and one at Royal Perth, if not planned. Are they the answer or an effective way to deal with the problems that have been outlined?

Dr Mark Duncan-Smith: Increased ability to deal with patients is always welcomed, but an ambulatory emergency department is not going to create beds in the hospital system. This report identifies that patients are seen, determined to be needing a bed, and then have to wait longer than acceptable to get a bed in the hospital. Once a hospital goes over 90 per cent occupancy, it becomes inefficient, it becomes more dangerous, worse outcomes, bed block, ramping and cancellation of elective surgery.

Our hospitals in WA are sometimes over 100 per cent occupied, as evidenced by over-census beds. This position is unacceptable. The AMA (WA) calls on the McGowan Government to actively adopt a policy to bring our bed stock up to the national average and keep it there. West Australians have worked hard to provide the McGowan Government with a $6 billion surplus. West Australians prioritise healthcare: quality health care and safe healthcare. So, we call on the McGowan Government to increase that bed stock and spend that money wisely.

Reporter: So, your position on these ambulatory units is that they’re welcome, but they’re not the silver bullet. Is that a fair assumption?

Dr Mark Duncan-Smith: Ambulatory care models will help to reduce the number of patients in the emergency department, but these are not the ones that need hospital beds. These are patients that otherwise are not going to take up hospital beds and therefore they will not help with ramping. They will not help with hospital occupancy. And they will not help with bed block.

Reporter: May I ask how is it possible for the hospital occupation rate to go above 100 per cent?

Dr Mark Duncan-Smith: Yes, it is possible for hospital occupancy to go over 100 per cent. These are what constitute over-census beds. So, for example, if you’ve got a 30-bed ward and you’ve got two over-census beds, which are the ones that the nursing staff apparently refused to staff, then you’ve actually got 32 patients in your 30-bed ward. Now you multiply that across the hospital and you have over 100 per cent occupancy of the hospital.

Reporter: This morning, Premier Mark McGowan said that the report was grossly irresponsible and basically scaremongering. What’s your response?

Dr Mark Duncan-Smith: This report is not scaremongering. It’s based on accurate and dedicated research. Just because it’s an inconvenient truth doesn’t mean that the Premier has to call it scaremongering. Western Australian people prioritise safe and quality healthcare.