July 28, 2019
BY GRANT McARTHUR – HEALTH EDITOR
Emergency department doctors have “grave concerns for patients” as it can be revealed the state’s public hospitals, grappling with debts of tens of millions of dollars, are planning to slash costs.
Their concerns come as at least 18 hospitals demand financial bail out assurances from Victoria’s Department of Health in order to continue to operate while in debt over the next year.
Several Melbourne hospitals have confirmed they are facing debts of between $20 million and $45 million under the 2019-20 funding proposals offered to them by the Andrews Government.
Some regional health services with smaller budgets say they are under even greater financial pressure, although the government is still finalising the official Statement of Priorities funding agreements.
To deal with the looming health budget crisis the state government has established a razor gang to institute systems wide cost cutting measures.
The Department of Health has established a task force of hospital chief executives charged with finding cost-saving measures that can be rolled out across the public hospital network to help cope with tight budgets.
It comes as one hospital has told the Herald Sun it is examining options to scale back weekend surgery, while another is preparing for possible redundancies in coming months.
Australasian College for Emergency Medicine president Dr Simon Judkins spoke out yesterday, warning the time needed to assess patients and perform critical interventions was already being compromised.
“Budget shortfalls that affect hospital capacity and services will exacerbate an already critical situation in most EDs,” Dr Judkins said.
“In a bad flu year and at a time that 24 hour ED waits are blowing out across Victoria, particularly for mental health patients, any reduction in system capacity when, in fact, we need investment in growing ED capacity and improving access, will put patient care at further risk.
“The stress this puts on patients, families and front line staff is totally unacceptable.
“The clear danger for patients will be increased risk of medical error, delays to care and poor patient outcomes.”
Eighteen of Victoria’s 83 health services have formally requested the Department issue them a Letter of Comfort — a legal assurances the Government will provide financial support for at least the next 12 months — needed to satisfy the Auditor General that debt-plagued hospitals can continue operating.
After refusing official requests to issue the assurances earlier this year, the Department buckled to pressure last Tuesday — just hours after the Herald Sun revealed the looming health funding crisis — writing to all health service chief executives and informing them they had until the close of business on Monday to request a Letter of Comfort.
It is not known if additional struggling hospitals will seek financial assurances by Monday’s deadline, however a spokesman for Health Minister Jenny Mikakos said the measures “are nothing new”.
He said 16 health services received the financial assurances last year, while 24 were issued in 2016-17, well down on the 30+ annual requests under the former Coalition government.
“Hospitals are expected to be able to provide all the services they usually offer for a growing population within their operating budgets, which is why the Andrews Labor Government has delivered every Victorian hospital record funding every year — and once again this year,” the spokesman said.
Opposition health spokeswoman Georgie Crozier said Premier Daniel Andrews had created a funding crisis for the state’s public hospitals.
“Daniel Andrews and Labor can’t manage money, as a result Victorian hospitals are in the grips of a funding crisis and the lives of Victorians are being placed at risk,” Ms Crozier said.
“It is critical that Daniel Andrews stops playing politics with the lives of Victorians and immediately fix this crisis.
“It is extraordinary for Victorian public hospitals to ask for assurances from the Andrews Government that they will have enough funding to just be able to keep their doors open.”
As it prepares to take the state’s public hospitals to Fair Work over claims of unpaid wages, the Australian Medical Association has written to the nation’s medical colleges wanting them to ensure their trainees are receiving their full entitlements.
The AMA’s case identifies mounting instances of hospitals allegedly not paying doctors for their overtime or meeting their long service and superannuation requirements.
The Herald Sun believes several hospitals already have wage bills in the millions of dollars which they cannot pay under their current budgets.
Dr Simon Judkins’ letter
News media coverage on possible reductions in public hospital funding in the state of Victoria are of significant concern for emergency department clinicians across the state.
Patient safety and care in Emergency Departments (EDs) in Victoria is challenging at all times, but we have grave concerns for patients if budget cuts impact patient services.
Staff working in EDs are already struggling to meet the growing number of ambulance arrivals and patient presentations within current resources.
Budget shortfalls that impact hospital capacity and services will exacerbate an already critical situation in most EDs.
In a bad flu year and at a time that 24 hour ED waits are blowing out across Victoria, particularly for mental health patients, any reduction in system capacity when, in fact, we need investment in growing ED capacity and improving access, will put patient care at further risk.
The stress this puts on patients, families and frontline staff is totally unacceptable.
The clear danger for patients will be increased risk of medical error, delays to care and poor patient outcomes.
It will compromise the ability of EDs to be able to see and assess patients in any appropriate time frame and provide the focused care needed in those critical time frames. It’s that simple.
Critical interventions are already compromised in our overcrowded EDs. Staff are describing an intolerable situation for patients in waiting rooms and hallways.
Yet Emergency Departments are facing pressure from Government to do things faster.
The impacts on staff can also be significant; the dedicated workforce of ED staff who come to work to help patients each day are feeling the pressure, with many experienced staff choosing to leave this increasingly stressful environment. These are serious and significant concerns.
Our EDs are the frontline of care for many communities. They need to be well resourced, well supported, and ready to care for patients when, and where they need it.
Our current situation, of long waits, frustrated staff, and increasing pressure to reach unrealistic performance indicators, needs urgent attention.