Federal Politics


'Fixing' hospital queues is no cure

A scandal is apparently unfolding at The Canberra Hospital, where a senior official allegedly tampered with emergency department waiting-time data. The ACT Auditor-General is now investigating and politicians are telling us that this grave breach must be ''fixed'' as a matter of urgency.

Yet there's a bigger problem that neither the government, the opposition nor the hospital itself have mentioned: they are focused on entirely the wrong scandal, and are dudding us in the process. Indeed, in trying to shorten waiting times, they are more likely to worsen health outcomes for Canberrans than improve them.

In some ways, I don't blame our local MLAs for being obsessed with hospital queues; it's a national pastime. We do it because we can. Governments have always tended to focus their energies on ''fixing'' issues that can be measured, because they know that those measurements can be used to judge them. Waiting times are relatively simple to measure, so, over the years, they've come to dominate political debate about healthcare. When these times lengthen, oppositions pounce on government ''failures''. When they shorten, governments trumpet the effectiveness of their ''reforms''.

Yet look at what happens when hospitals are pressured to shorten queues, whether for emergency treatment or other procedures. To avoid ''bed block'' (when hospitals can't admit new patients because no beds are available), doctors and ward administrators must discharge their existing patients more quickly. As a result, errors begin to creep into their care. Patients leave without discharge letters for their GPs, or without complete doses of their medication. Some are discharged prematurely or without a precise diagnosis when, ideally, their doctor should have observed them for longer. Stressed medical and nursing staff in packed, busy wards start to cut corners and skimp on procedure. Simple steps, such as washing hands between patients, are forgotten.

The outcomes of these pressures? More patients end up coming back, infections spread within wards, doctors are sued for negligence - everyone loses.

Yet rather than try to limit these risks, the federal government has, incredibly, chosen to amplify them. It recently set aside ''reward payments'' for states and territories that manage to shorten their hospital waiting lists.


We need only look to Britain to see what's likely to happen here. A decade ago, the Blair government introduced similar targets for its healthcare system. Inevitably, hospitals began to ''game'' the system by prioritising their services around data collection rather than around the needs of patients. In some cases, they even distorted the data. A study published in Public Administration in 2006, ''What's measured is what matters: targets and gaming in the English public healthcare system'', found ''enough evidence of significant gaming to indicate that the problem was far from trivial''. Earlier this year, the Medical Journal of Australia reported on similar problems emerging in Victoria.

No one likes queues. There are few more awful experiences for a parent than sitting in a hospital waiting room, for hours, with a sick infant who is clearly in pain.

Yet queues are an economic problem, not a medical problem. They're a form of rationing for a service that's too scarce to satisfy demand. And despite the political hyperbole around waiting times, our hospital queues will continue to grow; we simply cannot avoid it. Our population is ageing and becoming more reliant on medical care. We will only be able to fund a universal healthcare system if we increase the amount of rationing that controls how it is accessed.

If our politicians were genuinely interested in healthcare, they'd demand that hospitals publish meaningful measures of quality: data such as readmission rates (which can highlight problems with the initial care of patients), ward infection rates (which show whether hygiene controls work) and in-hospital death rates (which can indicate whether staff skills are adequate). But we must end the continuing hoopla around waiting times. It's more than just a distraction: it's bad for our health.

Markus Mannheim edits The Public Sector Informant. Send your tips to aps6@canberratimes.com.au