The community is alarmed and frightened by reports of deaths occurring in the community before arrival of ambulances and of the escalating episodes of ‘code red’ and ambulance ramping. More ambulances and more paramedics are promised.
If we have pain from cancer, we treat both the pain and the underlying cancer where possible. Treating a symptom without addressing the underlying cause makes no sense.
The underlying causes of ramping, ambulance service saturation and emergency department overcrowding need to be recognised and treated. They are not complicated.
Problem 1: Structure. We don’t have enough health infrastructure or funding. Australian health spending is inadequate. In dollars per capita, we spend around 20% less than like economies and in terms of percentage of GDP our 10.6% spent on health sits 1.5-2% behind similar countries[1]. As a result we have 10-15% less hospital beds[2] for acute care and 40% less intensive care beds[3] per capita than the OECD average.
Problem 2: Process. We don’t have adequate systems in place to manage and resolve the key constraints which limit the efficiency and safety of our health systems. That doesn’t mean they are a wreck, but they are not what they could be. The quality and safety movement in health has achieved much in the last 20 years however our hospitals remain full of bottlenecks and queues for patients to navigate through and out of. Some of these are due to the perversity of arrangements between the states and commonwealth especially in the aged care and disability sectors.
It’s time to fix this underlying malaise in our health system and stop pretending to the public that limited symptom management can cure cancer.
The solution: more money and flow. Staff, beds, hospitals and continuous effective improvement to safe patient flow through our systems.
The responsibility for this sits with federal and state governments who must commit with integrity to pursuing these solutions collaboratively, AND with health departments to drive the policy and funding frameworks to facilitate change, AND with hospital executives to accept accountability for delivering on this.
Ambulance ramping is not the problem.
[1] https://data.oecd.org/healthres/health-spending.htm
[2] https://www.oecd-ilibrary.org/sites/e5a80353-en/index.html?itemId=/content/component/e5a80353-en#figure-d1e5118
[3] https://www.oecd-ilibrary.org/sites/e5a80353-en/index.html?itemId=/content/component/e5a80353-en#figure-d1e5132
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