Failing Health

Federal Treasurer Josh Frydenberg is expected to hand down the first surplus in a decade on Tuesday, and according to the Coalition, this is a key sign of a flourishing economy. After 5 years of Liberal governance, delivering a surplus should be a crowning achievement for the government, and it will likely form the basis of their entire election campaign.

One issue likely to be mentioned in the budget will be health funding, with the NSW Liberal government having spent billions of dollars to expand existing hospitals in major Sydney hubs.

For the Abbott/Turnbull/Morrison government, announcing a surplus while delivering on infrastructure promises is a key marker of “responsible economic management”.

Despite this, Blacktown Hospital is so critically underfunded that entire wards are remaining closed due to the lack of staff, and staff across the state have claimed that it’s not the only hospital facing such a desperate shortage.

Interviews with dozens of doctors, nurses, Allied Health workers, and senior management have revealed shocking work conditions and serious concerns about the ability of hospitals to staff newly-built wards, let alone existing departments.

Very few voters would be shocked to hear that the staffing levels in hospitals are inadequate, but the reality of the situation would suggest that NSW Health is on the brink of collapse.

The expansion of a number of hospitals was a key pillar of the NSW Liberal government’s re-election campaign, going some way to helping them achieve a majority in Parliament. Over the past 6 years, Blacktown Hospital has more than tripled in size to become one of the biggest hospitals in Western Sydney.

When the expansion is complete it will be the size of Westmead hospital, but senior management at Blacktown have said that the number of staff employed will be less than half of those at Westmead.

Going into the state election, both parties made general promises around staff and nurses, with the Liberals promising 5000 nurses across the state over the next 4 years, and Labor heading in the direction of guaranteeing nurse-to-patient ratios.

There is a lot of scepticism inside the hospitals as to how the promise of 5000 nurses would be delivered now the Liberals are back in power, especially when 5000 additional nurses wouldn’t even come close to meeting patient needs.

One major problem for the hospitals: it is three whole months until the end of June, and hospitals have completely run out of the money allocated to their staffing budgets for the 2018/19 financial year. This means staff calling in sick are not replaced, instead those already working are forced to work overtime or double shifts, and as a result, the safety of nurses and patients is compromised.

At Blacktown Hospital alone staff budgets have been cut by 25% over forward growth, while the projected patient flow predicts a 200% surge over the same five year period.

This is particularly important because the Department of Health does not want these numbers to be made public.

Newly-built speciality wards, designed for respiratory care, dementia, and paediatrics are either being kept closed or are designated for use as patient overflow – despite the fact that some are being used for their intended purpose. This means that these wards, on paper, do not need specialists or full staffing levels, even though they have patients requiring this high-level of care.

Due to the size of the hospital following the Stage 2 expansion, critical care equipment is being transported hundreds (some days thousands) of metres a day, due to the lack of investment in life-saving instruments. One bladder scanning machine can be spread across multiple wards, with staff fighting over which ward needs it more at any given time, as the hospital only has one per floor.

Staff are spread thin caring for patients with high care needs, meaning patients are left in the lurch and lives are endangered as someone is sent to find necessary equipment, all so the health department can save some money.

State-funded specialist roles have been left vacant for months, even years, at a time to facilitate a better budget result for the hospital. Patients have been going without critical care in this time as the specially trained medical staff required for their treatment do not exist within the hospital.

Some speciality staff have been forced to take on multiple roles because the hospital refuses to replace them or fill vacancies.

There have also been claims from those working within the hospital of incidents where staff and patient safety was jeopardised as a result of the understaffing in speciality wards. Nursing staff claimed that there were days they were too scared to go to work because of the genuine fear they had for their lives, and said that there has been an increasing number of near-misses where the only thing that came between a nurse being assaulted or killed by a patient was luck.

The reports of these incidents are not allowed to be made public.

Over the last 6 years, the Liberal government under Barry O’Farrell, Mike Baird, and Gladys Berejiklian have made the expansion of Blacktown Hospital a central policy project – spending billions of dollars on the upgrades.

They have capitalised on every opportunity they have, holding press conferences and photo opportunities at the hospital as each stage of the upgrade is completed.

At no point have they ever had to discuss the fact that their announced funding for infrastructure upgrades does not include the necessary funding for staff.

In June last year the Premier, Gladys Berejiklian, and her Treasurer, Dominic Perrottet, announced a $3.9 billion surplus in the NSW budget, which was upgraded to $4.2 billion later in the year.

Two months after this surplus was announced, a nurse was stabbed by a patient inside Blacktown hospital, in an incident that can be directly attributed to the lack of staff in the ward.

The hospital has not even begun the hiring process for the newly built and expanded speciality wards, despite the fact that Stage 2 of the expansion project is due for completion later this year. According to some staff members from Mount Druitt Hospital, there is presently no plan to open the paediatric ward at Blacktown – even though the announcement of the ward formed a key part of Health Minister Brad Hazzard’s visit to the hospital last year.

During the state election, NSW Premier Gladys Berejiklian visited Blacktown Hospital for a campaign stop to spruik the new “world-class” maternity ward and paediatric unit, despite the fact that internal emails seen by this blog clearly state that the ward will not be opened after construction finishes later this year.

At Nepean Hospital in Penrith, staff in the emergency department are receiving text messages almost daily advising that they are understaffed due to sick leave, often across multiple shifts – and, as stated above, none of the absent staff are being replaced.

As a result, beds are having to be closed, which is increasing waiting times for treatment, and as a result attacks, assaults, and police callouts at Nepean Hospital have surged over the last few years.

In October last year police were forced to shoot a man outside the emergency department as he was brandishing two knives and behaving “erratically”.

A redevelopment project at Nepean costing $1B will likely add to these issues as staffing dips with no major investment in trained specialty staff or security personnel.

While at least twelve new junior nurses have recently been hired for the Nepean emergency department, their presence can add to the burden of those already working in the department as they don’t yet have specialty training in critical skills such as triage or resuscitation.

In Wollongong, one staff member spoke of a young woman in her 20s who spent three days in the ICU after a suicide attempt late last year, only to be released without a psychiatric evaluation because staff didn’t have time to check on her. This same young woman was in the hospital again this month after a second suicide attempt, released hours after being admitted under police escort to the emergency department – with nothing more than a promise to visit her GP.

One would be safe to assume that, should the young woman end her life, the hospital would be in breach of its duty of care.

Voters need to know the truth about where their tax dollars are going. Building new hospitals and expanding existing hospital infrastructure looks great for a new Treasurer handing down a budget, but without trained staff, people will die.

Hiring staff to ensure the hospital is run effectively, with patient-focused care front and centre, may not be sexy enough to drag the Daily Telegraph out for a write-up, but it is what is required for citizens to benefit from the services they are paying for.

The staff at these hospitals are risking their lives every day, and they carry the guilt of any patient for whom they are unable to provide adequate care.
Due to the lack of support they have experienced from NSW Health as well as the State and Federal Governments, staff have even reported that they are developing symptoms of PTSD.

Speaking out means risking their jobs, the doctors, nurses, Allied Health workers, and senior staff who chose to come forward for this article would only speak on condition of anonymity.

However, a rudimentary search on social media highlights the growing discontent around the need for nurses and speciality staff on the floor, with thousands of comments discussing long wait times and nurses being run off their feet.

Tracking down health workers for this article was a challenge, but not impossible; if any journalist was prepared to turn over enough stones, they could find a whole lot more, especially considering how much had to be cut from this article to protect the identities of those who came forward.

It is important to note that it is not just nurses feeling the strain. All of those interviewed described high-levels of stress and feeling overwhelmed by the critical shortages faced by these hospitals.

Anyone who has ever managed staff knows how difficult it can be to combat low morale, and how it affects the ability of anyone trying to do their job. When a simple mistake can mean the difference between life and death, issues of morale become all the more dangerous.

Health professionals already have one of the highest rates of suicide of any profession in the country.

The government needs to address this critical shortage before the election. Neither the Liberal Party nor the Labor Party are making announcements that give any indication that they are aware of the crisis faced by public hospitals. If this is happening in NSW, then we can be certain the funding crisis has spread across the country.

It all seems to point to an imminent disaster in health, and if nothing changes, we all lose.

This originally appeared on AusVotes 2019

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