I’ve been a little busy elsewhere but haven’t stopped counting down.
In total, Victoria’s public health sector has lost $723 million in the two years since Premier Baillieu took office; 85% of the funding cuts have been initiated by his government – not that you’d know that from the media coverage, government releases, or from the responses of many hospitals.
As the Federal and State governments continue to bicker, despite calls for compromise, it’s our patients who will suffer, and our already pressured staff who will feel the strain.
What do funding cuts mean? Here, off the top of my head and informed by both current practice and my memories of the Kennett years, are a couple of things that have been or will be implemented in hospitals across the state:
- Elective lists, already at 7000, get longer;
- inpatients have to wait for surgery – like the elderly mother of a friend and colleague, who waited three days for surgery to repair a fractured hip, even though research clearly demonstrates that delays increase the already poor outcomes of this population;
- patients are sent home to make room for new admissions, even if they’re not ready for discharge – which not only affects their progress but, if they need to be readmitted, means the hospitals can’t bill for subsequent related admissions;
- nurses are already being asked to work reduced shift lengths and to reduce their total hours, even though patient numbers aren’t decreasing and acuity is only rising;
- fewer allied health services (physiotherapy, nutrition, occupational therapy, speech pathology, podiatry and others) are available, for both in- and out-patients;
- support services like pathology, orderlies and cleaners are reduced, increasing the length of time everything takes to be done;
- kitchen staff are cut, increasing the likelihood of patients getting the wrong meals – for those on modified diets, like people with coeliac disease, diabetes, or who’ve had a stroke, this can have significant ramifications;
- linen deliveries are reduced, making it harder to get blankets when patients are cold, and encouraging wet linen to be covered up with pads rather than changed;
- the process for getting additional services is longer, harder, and requires justification – things like an air mattress for someone at high risk of developing a pressure ulcer, or an attendant to monitor a confused patient at risk of pulling out vital lines, falling out of bed, or wandering out of the ward; and
- structural changes like combining smaller wards to cut the cost of ward-level management, even though that makes it often impossible for staff to be adequately supervised or supported.
Victoria’s nurses, midwives and patients are fortunate – thanks to the sustained, committed work of past and present Australian Nursing Federation (Vic. branch) staff, board, executive and members, we have legally mandated minimum ratios. That means that, regardless of the severity of cuts, public hospitals can not increase patient loads above their current level.
Our world first ratios haven’t changed since they were implemented in 2000, although patients in every region and at every level are not more likely to be sicker and have more concomitant conditions (co-morbidities) now than then. Acknowledging this, some areas in some hospitals staff above the legal minimum – allowing, for example, the night duty in charge nurse to have a reduced patient load instead of caring for eight patients while running the ward. That will change, in almost every instance.
Things could be worse – at least our ratios mean that, unlike the recent cuts at Brisbane’s Prince Charles hospital, combining wards doesn’t mean managing the same number of acute surgical patients with twenty-five fewer nurses.
Victoria votes in a year, ten months, two weeks and four days from now. It’s not just nurses and midwives – none of us can afford to forget the impact that the Baillieu government’s short-sighted cuts are having on the health of our most vulnerable members, and on the functional integrity of what was a smoothly running health system.