‘Not what emergency care is about’: Major funding shake-up for NSW hospitals

Sydney Morning Herald, 24 August 2023

The NSW government will embark on a once-in-a-generation overhaul of the state’s health network, with Health Minister Ryan Park vowing to crack down on wasteful spending in the $33 billion system while also flagging changes to spending on locum doctors and hospital emergency departments.

Park will on Thursday announce the terms of reference for a special commission of inquiry into health spending in NSW. The inquiry, to be headed by senior counsel Richard Beasley and operate with royal commission-style powers, will conduct a root-and-branch review of the hospital system including the Local Health District structure.

Terms of reference reveal the commission will be tasked with reviewing the entire structure of the health system, including the creeping over-reliance on emergency care in hospitals and whether current funding “supports or obstructs” access to community health providers such as general practitioners.

“If we’re able to divert people away from emergency departments for instance, through better use of community-based care, that’s a good thing,” Park said. “When I was a kid, you would have to be missing two arms and two legs before my parents would take me [to an emergency department].

“I’m being flippant, but because of challenges around primary care and access to care in the community, they’re starting to be used as the point of all health contacts. That’s not really what emergency care is about.”

Pressure on emergency departments has been growing for more than a decade due to an ageing population and a lack of primary care options.

Park told the Herald an already stretched health system had been placed under significant pressure as it emerges from the COVID-19 pandemic. Latest health data shows that between January and March this year almost one in three patients did not commence treatment in emergency departments within the recommended timeframes.

In the same period 63,282 patients left an emergency department without completing treatment, including 8856 across south-west Sydney and 5880 across western Sydney.

That, Park said, was the result of severe strain being placed on staff inside hospital emergency departments as a result of failures in primary care.

“Pressure on staff is enormous. Trying to keep staff is a daily challenge. And that’s because the workloads are so significant,” he said.

The terms of reference for the inquiry also include the use of locum doctors, visiting medical officers, agency staff “and other temporary staff arrangements”.

It comes after the Herald previously revealed NSW is paying millions of dollars to third-party companies responsible for finding temporary doctors and nurses to plug gaps in critically understaffed NSW hospitals, something Park said would be a focus.

Park said he was particularly concerned with the more than $1 billion the state spends annually on locum doctors and visiting specialists, particularly in regional areas.

“We’re spending an enormously large amount of money on locums. Now, we need them, they’re important, but we have got to have a look at that and whether it’s the most efficient use of resources,” he said.

The previous Coalition government, along with the Victorian Labor government, had sought to push the federal government to overhaul Medicare schedule rebates to encourage more bulk-billing general practitioners into the health system.

Park said the new government was going in the same direction, but also acknowledging there was no choice but to “do some lifting outside of a traditional state government” through programs such as urgent care services for non-life-threatening conditions.

But, he said, the commission would inform “what discussions I might be able to have with the Commonwealth” on funding reform.

The special commission of inquiry was a key demand of the powerful Health Services Union before the election. Its outspoken secretary, Gerard Hayes, believes billions of dollars in wastage can be saved, which he wants to be redirected to staff.

While Park said he would wait for the inquiry’s findings – its terms of reference include reviewing the “capacity and capability” of the workforce is sufficient to meet the growing demand on the health system – he said “part of that is making sure we keep the staff delivering that health care”.

The inquiry is due to report its findings by August next year.