Like a heart-attack victim who can no longer pretend his or her discomfort is caused by indigestion, Canberra Hospital administrators have this week had to contemplate the reality that patient pressure can be disregarded no longer, and that urgent corrective action is required. In response to figures indicating the facility has averaged 95 per cent capacity so far this year – which emergency department clinical director Michael Hall has characterised as "unsafe" – administrators have presented the ACT government with a new "overcapacity protocol". Under the proposed plan, patients close to being discharged from busy wards will be placed in areas not normally used to house beds to allow additional patients from the hospital's emergency department to be accommodated. By such means, up to 10 beds could be freed during those times when the hospital was operating close to capacity.
As far back as 2009, concerns were being expressed about the ACT public hospital system's approach to full capacity, and for the government and health policy-makers to have let matters slide until Canberra's main hospital was bulging at the seams suggests, at the very least, inattention to detail. Admission records indicate that presentations at the emergency departments of Canberra and Calvary hospitals have continued to grow strongly in recent years, despite extra funding for alternative services such as walk-in centres, community health centres, and more recently the National Home Doctor Service. Canberra Hospital administrator Mark Dykgraaf has said the facility will introduce 45 new beds this financial year, with 27 of those planned to be opened by early next month. But strong population growth in the ACT, and the tendency of people to choose Canberra Hospital ahead of Calvary, suggests if the extra beds do reduce occupancy to the 85 per cent recommended by the Australian Medical Association, relief may be short-lived.
Canberra Liberals Leader Jeremy Hanson has asked why it is that Canberra's hospitals are underperforming relative to those elsewhere in Australia, and while politically motivated, the question is nonetheless worth posing in a wider context. The Territory is, after all, a relatively prosperous jurisdiction with no requirement to provide health care to remote or distant communities. It has no difficulty attracting and keeping doctors and clinicians. It even has a medical school adding to the Territory's medical stocks. Yet, on bed numbers and other performance indicators such as emergency response times and surgery waiting lists, the Territory is a noted laggard. To add insult to patient injury, Canberra and Calvary hospitals are among the most expensive to run in Australia. This (disturbingly) has been attributed in part to high administrative costs and the fact that a third of hospital employees are members of the Commonwealth's very generous defined-benefit superannuation scheme, now closed. It turns out, too, that the provision of specialist services and facilities at Canberra Hospital has also led to "diseconomies of scale".
Given the likelihood these will be retained to ensure people needing cardio-thoracic surgery or other complex procedures are not condemned to have to travel to Sydney – and the probability that there is little administrative fat waiting to be cut – what are the prospects the overcapacity proposal will work as planned? Fair to good, probably. But the likelihood that cobbling together an extra 10 beds at times of stress will make much of a difference long term is to be doubted. Dr Hall believes so too, and says that tough political decisions are needed to alleviate the pressure in areas like emergency care. He has suggested cutting back on elective surgery and running the hospital on a 24-hour, seven-day-a-week model in order to to maximise its resources. Elective surgery lists are a something of a hot political potato, and no government would venture to cut them willingly. That said, there is scope for shifting more of these procedures over to private hospitals. What perhaps makes better sense is ensuring that expensive operating theatres are put to greater use. There is nothing preventing these being run in shifts around the clock, except perhaps the view that the sick or injured should be obliging at all times and await their turns. Such views need to be overturned if the house-full sign is not to become a permanent feature at Canberra Hospital.