According to the AMA’s upcoming 2023 Public Hospital Report Card, the NSW Health system’s performance fell across the board.
Despite being the strongest performing State overall, NSW was one of only two States to fall across all four key performance metrics studied by the report card.
“All that holds the NSW health system together is the goodwill of devoted workers showing up, going above, beyond and even further to keep servicing the patients of this state. But as demand increases and resources are cut the workforce can’t and won’t continue limping along.”
Dr Michael Bonning, AMA (NSW) PresidentHEALTH WAS NEVER EXPECTED to be a priority in the Minns Government’s initial budget. It wasn’t a prominent issue during the Labor Party’s campaign leading up to last year’s State election. Consequently, the announcement of a mere 0.87% increase in health spending for 2023-24, bringing the total to $30.951 billion from the previous year’s $30.684 billion, was met with criticism. Dr Michael Bonning, President of AMA (NSW), labelled this increase as “paltry.”
Taking into account health inflation, estimated at 8% last year, the real terms of this increase amounted to a 7% decline. This has left the already strained NSW Health workforce grappling with a significant budgetary shortfall compared to the previous year.
Dr Bonning said the repercussions have been felt acutely across the State. “While the Covid threat has waned, the NSW Health system faces new and increasing challenges,” he said, “including ambulance ramping, hospital log jam, long planned surgery waitlists, and the pressure from our growing and ageing population with complex, chronic health conditions.”
“Our drastically overburdened health workforce cannot continue to perform under the current conditions and needs an urgent injection of health dollars,” Dr Bonning said. “I’m not sure the government realises how close the entire health system is to collapse.”
The effect of the cuts is being felt at a time when New South Wales is facing record demand. Statistics paint a grim picture of a system in crisis.
According to the NSW Bureau of Health and Information, in the period between October 1 and December 31, 2023:
» Ambulance activity was higher than any quarter since the BHI began reporting in 2010 at 379,705 responses including a record 14,741 “highest priority – P1A” responses for patients with a life-threatening condition, up a staggering 34.8% (3,804) from the same quarter the previous year.
» There were 798,813 ED attendances, up from 790,309 in the same period last year, and up 2.9% on pre-pandemic levels.
» EDs continued to see more of the most urgent patients with 6,649 triage 1 presentations and 119,389 triage 2 presentations – both the highest of any quarter since BHI started reporting in 2010.
» While 58.1% of patients spent less than four hours in the ED, a slight improvement on the record low in the preceding quarter, one in 10 patients spent longer than 10 hours 30 minutes in the ED – well above pre-pandemic levels.
» There were 497, 870 admitted patient episodes – up 4.6% (21,838) from the same quarter the previous year.
» There were 230,643 acute sameday patient episodes – the largest increase (5.9%) in this type of care
compared to pre-pandemic levels.
» The average length of stay for overnight non-acute episodes was 16.7 days, 12.8% higher than prepandemic levels.
According to the AMA’s upcoming 2023 Public Hospital Report Card, the NSW Health system’s performance fell across the board. Despite being the strongest performing State overall, NSW was one of only two States to fall across all four key performance metrics studied by the report card. Patient outcomes worsened for the percentage of Emergency Department Category 3 patients seen within 30 minutes, the proportion of patients leaving the Emergency Department within four hours or less, median waiting time for elective surgery and the percentage of Category 2 patients seen on time (90 days).
“These figures should be a wakeup call for the NSW government,” Dr Bonning said. “The health system is crumbling under unprecedented demand, while staff try to manage after funding cuts delivered in the Minns Government’s first budget.”
Meanwhile, the AMA (NSW) has been receiving calls from doctors
who are at wits’ end, barely able to function in their jobs because they don’t have the necessary staffing or equipment. Doctors report feeling at breaking point, grappling with a workload that far exceeds capacity.
“Lots of our long-term staff are leaving, reducing hours or not putting in extra hours and effort because it’s impossible to continue full-time in this environment,” lamented a metropolitan hospital specialist, who has felt the need to reduce her own workload under such conditions.
“In the hope that it might save me from leaving medicine altogether, I have dropped to half-time and resigned from many leadership roles and rosters.”
One doctor in a metropolitan Sydney hospital told The NSW Doctor, “It’s been happening over the past few months. We aren’t given staff to fill vacancies. We can’t backfill for maternity leave. I’ve never seen it like this. I don’t know
what we’re expected to do.”
A metropolitan hospital psychologist weighs in: “Staff are burning out due to the increased complexity, severity and number of patients. Budgets aren’t matched to population growth, so staff are expected to do the same amount with less resources.”
“The biggest State-wide issue is lack of staff, as there are not enough doctors and nurses to patient ratios,” a doctor-in-training who has worked in regional and metropolitan hospitals said.
“With many (doctors) calling in sick and quitting, the shortages burden existing staff. It’s a negative feedback loop reflecting a system that’s not coping which will get worse unless the NSW Government does something.”
Staff shortages are now so chronic that desperate measures
“Staff are burning out due to the increased complexity, severity and number of patients. Budgets aren’t matched to population growth, so staff are expected to do the same amount with less resources.”
are used to spread out employees, with staff taking on roles they are unqualified or underqualified to perform while others simply take on a much greater workload, without additional remuneration.
WE ASKED OUR AMA (NSW) COUNCILLORS WHAT THEY WERE SEEING ON THE GROUND: AMA (NSW) Councillor Dr Anne Rasmussen is a senior anaesthetist. She notes, “There’s been an attrition of experienced nursing staff across NSW. Obviously, the award is less for nurses in NSW, so we’ve lost nursing staff to Queensland in particular. In my field of anaesthetics, where we normally had nurses we’ve worked with for a long time, we’re now being introduced to the new anaesthetic nurse on the day, who’s actually never been in an operating theatre before, because she’s the only one who applied for the job.
“We as surgeons have been ordered to train nursing staff in theatre. My colleague in a metropolitan hospital has been asked to use nursing assistants to do what are traditionally nursing roles because of nursing shortages. That’s never happened in my career before but that’s probably the direction we’re heading to.”
A metropolitan staff specialist complained, “There is such a shortage of nursing staff in the Intensive Care Unit (ICU). Nurses are regularly deployed to wards whose processes they’re unfamiliar with, so ICU has a smaller capacity and must refuse patients. This results in inefficient and deficient care, and care for ICU patients decreases plus we have to delay or refuse new patients from ED.”
Fellow AMA (NSW) Councillor, Neonatologist Dr Eveline Staub said, “Staff shortages lead to a costly logjam, with the postnatal ward unable to meet the 11am discharge
“The NSW health system has repeatedly been recognised as one of the most effective systems within Australia. Despite its strengths, the NSW public health system risks losing its status if it is not possible to attract and retain doctors to work in it,”
Dr Michael Bonning, AMA (NSW) President
time because the junior doctor who examines babies prior to leaving has higher priority jobs, including deliveries. Baby checks are their least acute task so mothers often wait all day for that examination then can’t go home until late afternoon, which causes bed block and patient flow problems that our department gets reprimanded for.”
It’s not just staffing shortages, it’s equipment ordered, that has never arrived. Dr Staub said, “We have continually requested new equipment in anticipation of old devices becoming redundant, but it wasn’t approved so we had no functional equipment to cool babies after birth asphyxia, which is an essential service the Ministry tasks us with.”
“Scrambling ensued and the matter escalated through the hospital ranks until two new devices were ordered and delivered but they had to be paid for by donations, which is the desperate situations hospitals are finding themselves in across the State,” she added.
Another rural surgeon spoke of similar issues: “An ultrasound machine was approved but after the funding cuts last year we weren’t allowed to purchase it. As a result, we have to wait until the equipment is free which causes theatre delays and decreased efficiency. It all has a roll-on effect.”
Many doctors have expressed frustration at what they describe as an information void. “We put in for
funding for things we need urgently, and we just don’t hear anything.”
A Western Sydney surgeon said, “No ‘yes’, no ‘no’, no nothing. It’s as if we never applied, and there’s no mechanism for asking where things are up to or why they haven’t arrived.”
One metropolitan hospital specialist lamented the lack of clarity from her facility’s management which doesn’t give prior notice to staff about resource cuts and refuses to reveal who makes such crucial decisions. “There’s no communication, no transparency, no accountability,” she said.
This western Sydney surgeon summed up: “It’s so short sighted. These financial plans are the ultimate false economy. There’s going to be cumulative delays in service, increasing inefficiencies in clinical services, it will impact and delay accessing care, particularly for elective cases. We need clinicians and associated services. It is selfdefeating to reduce costs and render yourself unable to care for any patients.”
In its submission to the Special Commission of Inquiry into Health Funding, AMA (NSW) wrote: “The New South Wales Government has dedicated significant funding to building new infrastructure, but there has not been the same resourcing dedicated to bolstering workforce numbers to staff the current and foreseeable institutions.”
In delivering AMA (NSW)’s prebudget submission Dr Michael
Bonning said, “We are calling on the Minns Government to commit to a substantial increase in health funding in the upcoming budget, as outlined in our submission.
In comparison to NSW, Dr Bonning said the Queensland Government increased its health budget by 9.6%. As the most populous state in Australia with an ABS Estimated Resident Population (ERP) of 8,339,300, NSW received $30,951 billion. Queensland, whose ERP is just 5,459,413, received $25.8 billion.
“Given NSW Health is the largest health care system in Australia and by the Department’s own admission one of the largest in the world, this hardly seems appropriate,” Dr Bonning said. “It is the people of NSW who will suffer,” Dr Bonning warned. “With less access to EDs, less urgent and non-urgent surgery, and our State’s innovative programs, such as the collaborative care projects, will be at risk.”
“The NSW health system has repeatedly been recognised as one of the most effective systems within Australia. Despite its strengths, the NSW public health system risks losing its status if it is not possible to attract and retain doctors to work in it,” Dr Bonning said. dr.