- by Tom Pearson and Anna Pha
- The Guardian
- Issue #2132
Photo: Anna Pha
Across the nation public hospitals are pushed well beyond their limits. Patients spend hours in corridors and waiting rooms of emergency departments waiting for beds to become available. Ambulances ramp, unable to offload patients in the emergency departments. Staff and resource shortages compound the problem. The system is in crisis.
Just as with Medicare, the public hospital system has been run down. Nurses and doctors are suffering burnout working in extremely stressful situations for long hours with no let up.
The Howard government began a campaign to drive people into private hospitals with higher premiums for those who join a private health insurance (PHI) fund after the age of 30.
Private hospitals are subsidised through a federal government subsidy of PHI to the tune of more than $7 billion per annum.
The public are told that private hospitals are superior to public ones, that you have a choice of doctor, and that using a private hospital takes pressure of the public hospital system.
Public hospitals offer quality services. The money spent subsidising private hospitals diverts badly needed funds from the public sector.
Between 2012-13 and 2022-23 , federal government spending on public hospitals increased by 4.3 per cent on average and state and territory spending by 5.0 per cent on average. This hardly kept up with the increase in population and rise in the cost of health services, let alone that people are now living longer and have more chronic conditions.
Wait times for ‘elective surgery’ continued to blow out in in 23-24 with more than one in three patients waiting longer than the clinically recommended time for essential surgeries, including heart valve replacements, and coronary artery bypass surgeries.
Nurses have taken to the streets seeking a living wage. In NSW funding and staff shortages is critical.
MENTAL HEALTH
NSW is the state with the lowest per capita spending on mental health with public psychiatrists going interstate, given the big pay gap for public psychiatrists compared with other states.
An ad in the Sydney Morning Herald on 24 January: “NSW psychiatrists – Queensland is calling. Seeking better pay? We already pay more.” Signed – “Queensland Health. Make a healthy career move.”
As of writing, more than half the psychiatrists in the NSW public health system had handed in their resignations due to chronic understaffing and under-resourcing. More were likely to resign. This followed 15 months of discussions in which the Minns Labor state government has played a belligerent, blocking role.
On 20 January the Australian Salaried Medical Officers’ Federation (ASMOF) stood side by side with psychiatrists, patients, carers, nurses, peer workers, and fellow doctors to urge the NSW government to avert disaster for communities and address the staffing crisis in NSW Health. ASMOF Executive Director Andrew Holland noted the failure of the Minns government to meet its commitment to the health workforce.
This failure, said Holland, is reflected in its “wait and see” approach to the psychiatry crisis, which has been escalating for over a year. It is also reflected in the government’s obstructive approach to negotiations with the union.
“It has become clear that we cannot sit and wait for NSW Premier Chris Minns or the Health Minister Ryan Park to address this crisis. The only power we have is through our collective voice and actions. We are calling on all members to urgently hold meetings with their departments to discuss the failure of the NSW government to negotiate with our union and offer a fair deal to doctors.”
Negotiations on the salary and working conditions of doctors in NSW have been constantly thwarted by the Minns government. The NSW Health representatives at the negotiating table are not interested in being there, not invested in problem-solving and have no power or decision-making authority.
“We have been speaking extensively to the media about the staffing shortages facing psychiatrists across NSW, and the impact on patient care and staff morale. We have also been challenging the NSW government’s inflated salary figures, and it’s attempts to paint the staffing crisis as a ‘pay dispute.’ ”
“NSW Health states that they cannot put anything on the table if there is not a net cost saving for the government,” the union told members, “therefore it is not possible to discuss any increase to your pay and improve your conditions outside their 3 per cent pay offer. The common refrain we hear at the table is ‘that’s a matter for central government.’ ”
These doctors could easily step into the private sector, take a locum position in their own hospital (for higher pay) or move interstate. Instead, public psychiatrists choose this work so they can care for some of the most marginalised people in our society and for people with the most severe mental illnesses.
And it is here, philosophically and ideologically, where the contradiction behind the dispute is to be found: the psychiatrists – and the wider public health workforce – have a commitment to public service, whereas Minns and his spin doctors have zero such commitment.
Minns and Park are refusing to put money on the table and it’s clear they have failed to give a clear mandate to their bureaucrats to reach agreement and are allowing them reject proposals for being too costly without providing any meaningful alternatives.
Nurses have also refused to be brought into the government’s contingency plans to deal with mental health patients. NSW Nurses and Midwives Association secretary Shaye Candish said mental health and emergency department nurses were angry that the government was pushing its plan onto them without consultation.
“This whole situation has been managed atrociously,” said Candish, noting the government’s arrogance. “No one has bothered to properly consult with our members, yet the premier has stated publicly that they expected us to fill in the shortfalls. It’s not acceptable.”
As Sydney-based psychiatrist Dr Pramudie Gunaratne puts it; “The caseloads for individual doctors are extreme. The injustice of sending patients away from our overloaded services when they are desperate for help weighs heavily.” She emphasises, “Our leaders need to have the courage to start fixing a broken system before there is no system left at all. The proposal to waste even more taxpayer dollars on locum [higher paid] psychiatrists may help the government save face in the short term, but it does nothing to save lives. Instead it will likely cause more harm.”
The Communist Party of Australia is calling for the nationalisation of the health system with an end to the subsidisation of private hospitals. Public hospitals should be adequately funded and staffed.
In particular it is time mental health was taken seriously and patients received the care and services they require. People with mental health illnesses are not second class citizens.
