By Sue Bolton
Intro = MELBOURNE — Health unions have begun taking action over the serious attacks on the public health system in Victoria. Health Services Union of Australia (HSUA) members at the Austin Hospital and the Heidelberg Repatriation Hospital walked off the job in September over the proposed merger of the two hospitals. Nurses at Geelong Hospital voted on October 4 to close beds if more staff were not provided. Ambulance officers began a campaign on October 16 to prevent the removal of their meal break allowance and are refusing to charge non-subscribing patients for ambulance transport.
On October 19, a mass meeting of Monash Medical Centre staff responded to the closure of 100 beds by refusing to close the beds and banning staff from applying for redundancies. Staff from St Vincent's hospital and the Kew Cottages have also taken strike action to stop cutbacks.
On October 25, six unions combined to protest outside the head office of the Department of Health. HSUA, Australian Nurses Federation (ANF), Medical Scientists Association, Australian Health Professionals Association and the Health and Community Services Union organised 5000 of their members to protest against funding cuts to hospitals, threatened staff cuts and the reduction in the standard of patient care.
At the demonstration, a local comedian, Rod Quantock, demonstrated the similarities between the Victorian public health system and a game of roulette.
Case-mix
Over the last two years, the Kennett government has cut $190 million from public hospital budgets. The cuts were implemented largely through a changed method of funding for public hospitals. The new funding formula was called case-mix.
Under case-mix funding patients are classified into diagnosis-related groups (DRGs) and hospitals receive set amounts according to the diagnosis. New mothers with inadequate home support, elderly and frail patients who take longer to recover and patients with post-operative complications don't attract as much funding as other patients.
This has led to hospitals competing for patients in the DRGs that attract high funding, and restricting the number of patients in the DRGs which attract low levels of funding. Patients in the low-funded DRGs are being discharged early.
In the case of small country hospitals where a disproportionate number of patients may be elderly or chronically ill, case-mix funding will lead to closures. It has already been announced that Moe's only hospital is likely to close. Moe hospital has had its budget slashed by $12 million, or 25%.
If Moe hospital does close, residents will have to travel 30 kilometres to Traralgon for hospital care. Residents of Moe have already responded with two rallies of 1500 people to protest against the closure.
The Age on September 26 quoted the Australian Medical Association in January as saying that the state government planned to close one third of Victoria's public hospitals by the next state election.
The following examples indicate the level of crisis in Victoria's public health system:
- About 100 emergency cases each week wait more than 16 minutes for an ambulance to arrive. The Ambulance Employees Association claimed on September 14 that response times of ambulances have been 64% slower than before the restructuring. The ambulance system has been working for most of this year with skeleton crews.
- The Metropolitan Ambulance Service is contracting out its emergency communications centre to a private company. The people staffing the emergency communications centre aren't necessarily former ambulance officers. This means that when someone rings up with an emergency, the person answering the phone may not know what the appropriate ambulance response should be.
- After publicity about an 86-year-old woman who had been left on a trolley for 24 hours in the Monash Medical Centre's emergency department, it was revealed that 30 patients in five of Melbourne's main hospitals had to stay in emergency departments for more than 48 hours during one month. More than 600 patients in April had to stay at least 12 hours in emergency departments at the Austin, Alfred, Monash, Western and Preston and Northcote community hospitals.
- Recently announced government funding changes have left shortfalls in the budgets of a number of hospitals. Royal Melbourne is short by $12 million, St Vincent's $10 million, Monash $10 million and the Austin $7 million. This has led to a board of management proposal from the Monash Medical Centre to close all 100 beds at its Moorabbin campus. The chief executive officer of Royal Melbourne Hospital, Jonathan Tribe, foreshadowed a review of service levels and staffing numbers. St Vincent's has ordered a 7% cut across all departments and the closure of a 24-bed ward.
More cuts
Despite the crisis in the hospitals, the Kennett government has refused to release extra funds to ensure the adequate provision of health services.
The Alfred Hospital announced on October 22 that it was considering closing its cardiac and AIDS wards. On July 1, the state government revised the amount of money it pays hospitals for many procedures. For example, the Alfred will get $280,000 less this year than last year for treating its HIV patients, $283,000 less for performing cardiac valve surgery and $99,000 less for inserting pacemakers.
Figures compiled by the Health Department showed that the Alfred Hospital told ambulances to bypass it 56 times in July, compared with 47 times last year and 25 two years ago. Public hospitals ask to be placed on bypass when they are full and unable to admit patients through their emergency departments. The Age on August 27 reported that earlier this year, the Alfred was on ambulance bypass continuously for 18 hours.
David Land, secretary of the Ambulance Employees Association, said on August 26 that all the big public hospital emergency departments were under stress. Nursing numbers had been reduced, and more patients were being transferred around hospitals in order to find beds. Land claimed that earlier this year, a patient at the Western Hospital had to wait 18 hours in casualty for an ambulance transfer.
A number of surgeons told the Sunday Age on October 22 that in most cases, hospitals admit patients on the day of surgery instead of the night before. This means that surgeons don't see patients until they arrive in the operating theatre.
A study by the Royal District Nursing Service has shown that since the introduction of case-mix funding, more public hospital patients are being readmitted because they are discharged too early. The RDNS study says that assessment for discharge in hospitals appears to be driven by pressure to comply with case-mix weightings or to make beds available for patients banked up on trolleys in emergency departments.
It is clear that the Victorian public health system is in crisis. What is needed is a massive injection of funds to reverse the draconian cuts implemented by the Kennett government and the ALP governments before it.
It was heartening that the hospital workers' rally on October 25 involved all six unions covering hospital workers. In the past it has been too easy to pick off different groups of hospital workers through the tactic of divide and rule.
However, to reverse the health cuts, a united campaign of industrial action and public rallies will be needed; a campaign which will involve all health workers. Such a campaign will also need to involve other unions and community groups — everybody is affected by the health cuts.