Hospital funding cuts have been making the Victorian news for the past couple of weeks, usually precipitated by closures at iconic institutions like the Royal Children’s Hospital (announced January 7th) and Peter MacCallum, Victoria’s cancer hospital (announced two days ago). The emphasis is often on elective surgery, which sadly misses the system-wide impact – also affected are emergency surgery, scanning (like MRI, CT and ordinary x-rays), emergency admissions, waiting times in emergency departments, far longer care by ambulance officers (because they’re unable to unload patients if nobody can care for them), and longer transport times, because of emergency departments ceasing night-time service.

Last night’s Melbourne news fairly comprehensively covered how Premier Baillieu’s press conference on Victorian health funding turned into an abbreviated debate with Federal Health Minister Plibersek – you can watch the ABC’s 7PM coverage, The Age‘s coverage, some unaired footage, read The Australian’s account, hear interviews with the two politicians (separately) on 3AW.

There are, as there always are, at least two sides. I’m sure that both sides have a degree of merit, and a degree of culpability. The Federal cuts are smaller, accounting for only 15% of the total budget reduction for public health funding since the Premier took office in 2010 – but they’ve been made mid-year, and include retrospective cuts for the 2011/12 financial year, which means services have to scramble to recoup funds already allocated, downsize services intended to cover another six months, and cover services that have already been provided.

Those budgets were already emaciated, thanks to $616 million already taken from a service that is treating more patients, more effectively every year – and lowering the rate of preventable andhospital-associated events despite an aging population with increasing co-morbidities. I do occasionally wonder just how much the protracted, dogged resistance to the ANF’s public sector EBA contributed to the Baillieu government’s need to economise.*

What’s more important is that both the State and Federal governments also have responsibility. One of the manifold roles of government is to serve the needs of the people – not just today, but in the long-term.

People don’t stop needing care because there are fewer beds – they just spend more time in increasingly frenetic emergency departments, or in the back of ambulances (because they can’t be unloaded when there are insufficient staff to care for them in the department). And that means more crews tied up, and fewer units on the road. See here for a longer discussion on ambulance ramping.

3AW presenter Neil Mitchell has called this bickering obscene, Monash Medical Centre surgeon Mr Alan Saunders described the dissent as “squabbling,” while ANF (Vic. branch) Secretary Lisa Fitzpatrick referred to the politicians as “squabbling children, it would seem, and I think somebody needs to show some parental guidance.”

We’re only just feeling the bite, and it’s going to get worse. In just the last three days colleagues across the state have told me:

  • that Frankston had four ambulances ramped for most of one night;
  • that Colac will shut out of hours service and six surgical beds, leaving the closest emergency department over an hour away, in Geelong – and they’re closing 26 beds;
  • that Werribee Mercy’s closed a ward – among other job losses are six graduate nurses who weren’t yet contracted and are now abandoned;
  • that nurses at the Royal Melbourne have been asked to drop their hours, though there’s no lesser need for care
  • and that there are few jobs anywhere in the system.

I’ve also been told about nurses who’ve lost their jobs, and others who have to reapply for positions they’ve help for years, because of organisational redesign.

I was a very junior nurse during the Kennett years, but experienced enough to know that the severe cuts weren’t sustainable. Twenty years on patients are far sicker than they were then, and patients are rarely in hospital unless there’s no recourse.

Victorian public sector nurses and midwives are a little insulated – thanks to the (now inadequate) ratios we fought for in 2000, and defended in 2001, 2004, 2007 and 20011/12, we can’t legally work with higher patent workloads. This is not the case for any other member of the health care team – allied health numbers can be cut, hospitals can hire fewer doctors, and support staff (like cleaners) are already employed in lower numbers, with less coverage.

Like the Baillieu government’s attack on education at every level, on educators at every level, this is an issue that affects all Victorians. We can not stand by and let a public health system that is strong, effective, resilient and cooperative die not a natural death but a slow and aggressive strangulation.

So how can you help?

Let the media know you’re concerned, by contacting the editors of the Herald-Sun, The Age and/or your local paper editors. Call talkback radio. If you use social media then post and tweet about your concerns, including journalists in your communication. Write to your State and Federal MP’s, expressing your concern. Talk about this issue with your friends, your neighbours, and  your colleagues.

And, on Sunday February 3rd, join your fellow Victorians at a family protest rally – activism combined with a barbeque and children’s entertainment. I’ll be there – with hundreds of red-clad nurses and midwives, fighting once more for the health and welfare of our citizens.

By our sides will be members of the teams who help us deliver some of Australia’s best care: cleaners, psychologists, medical technicians, orderlies, pathology technicians, mental health staff, allied health staff and (though the AMA hasn’t officially endorsed the rally) doctors.

At our backs will be members of the other unions that have helped keep Victoria, and Victorian workers, strong – because union values and family values, and human values, and because every single one of us will need access to quality, effective, skilled, safe and timely health care. If only our elected officials will let us.Rally poster - Feb 3 2013

*I went to a FairWork hearing in the earliest days of the strike action; there were two questions to be answered: were ANF members taking industrial action (yes, we were leaving patients’ bedsides), and was the action unprotected (yes, it wasn’t on the list of protected activity, and in any case we’d be ordered to stop all industrial action). There was no way that the ANF side could win – we fielded one (very talented) lawyer. The Victorian Hospitals Industry Association, the body used to represent the government in negotiations, had seven, and at least two of those were very expensive. My suspicion, based on no insider knowledge or discussion, is that they hoped ANF would go to court and be required to pay costs – the resulting bill might not bankrupt the union but it would make things very tight.